Purpose: Due to the preservation of the entire stomach after endoscopic resection, the occurrence of metachronous gastric cancer (MGC) remains a possibility. In this study, we investigated the incidence and risk factors for MGC in patients with early gastric cancer who underwent endoscopic submucosal dissection (ESD) and successfully eradicatedHelicobacter pylori. Materials and Methods: A retrospective analysis was conducted of 1,191 patients who underwent ESD and successfully eradicated H. pylori at the Affiliated Drum Tower Hospital of Nanjing University. Endoscopic surveillance was performed at 3, 6, and 12 months post-resection, and annually thereafter. MGC was defined as the development of a new cancer at a site other than the primary gastric cancer site, at least 1 year after the initial endoscopic resection. Results: A total of 77 patients were diagnosed with MGC during a median follow-up of 41.5 months. Kaplan-Meier analysis showed a 5-year cumulative incidence of MGC of 9.4% after successful H. pylori eradication. Multivariate analysis of the training set using Cox proportional hazards models identified male sex, severe atrophic gastritis, multiple gastric cancers before H. pylori eradication, and smoking history as independent risk factors for MGC.The nomogram exhibited favorable discrimination, with area under the curves of 0.767 and 0.822 in the training set and 0.724 and 0.745 in the testing set at 3 and 5 years, respectively. Conclusions Patients with gastric cancer who undergo endoscopic resection, even after successful H. pylori eradication, should undergo annual and continuous endoscopic surveillance for MGC.

OBJECTIVE To study the effects and mechanism of Portulaca oleracea cream on skin pruritus and barrier function in allergic contact dermatitis （ACD） mice. METHODS Low-concentration and high-concentration P. oleracea creams were prepared， with the P. oleracea extract solution （1 g/mL， calculated by crude drug） concentrations of 10% and 20%. Sixty BALB/c mice were randomly allocated into blank group， model group， Mometasone furoate cream group （positive control）， blank matrix cream group， P. oleracea low-concentration and high-concentration cream groups. Except for blank group， ACD model was induced in each group using 2，4-dinitrochlorobenzene solution. The blank group and model groups received normal saline， while the remaining groups were treated with their respective creams， once a day， at a dose of approximately 0.5 g per application， continuously for 14 days. At 24 h post-final administration， skin lesions of mice were observed and scored； pathological changes of skin tissue were observed； serum levels of immunoglobulin E（IgE） and tumor necrosis factor-α （TNF-α） were quantified. mRNA expression of MAS-related G protein-coupled receptors （including MrgprA3， MrgprC11， and MrgprD） in dorsal root ganglion （DRG） was assessed； while protein expressions of skin barrier function-related proteins Claudin-1 and Occludin in skin tissues were determined. RESULTS Compared with blank group， mice in the model group exhibited severe skin damage， characterized by loss of epidermal architecture， hyperkeratosis of the skin tissue， and the infiltration of a large number of inflammatory cells. The skin injury scores， as well as the serum levels of IgE and TNF-α， and the mRNA expression levels of MrgprA3， MrgprC11， and MrgprD in DRG， were all significantly elevated compared to the blank group （P＜0.05 or P＜0.01）； in contrast， the protein expression levels of Claudin-1 and Occludin in the skin tissue were markedly reduced （P＜0.05）. Compared with model group， mice in P. oleracea low-concentration and high- concentration cream groups demonstrated significant alleviation of skin damage， as evidenced by reduced epidermal hyperplasia， mitigated spongiosis in the dermis， and decreased infiltration of inflammatory cells； these quantitative indicators were almost significantly reversed （P＜0.05 or P＜0.01）. No significant differences were observed in the aforementioned skin injuries， pathological alterations， or quantitative indicators between the blank matrix cream group and the model group. CONCLUSIONS P. oleracea may ameliorate skin lesions and restore skin barrier function of ACD mice， the mechanism of which may be associated with downregulating mRNA expressions of MrgprA3， MrgprC11 and MrgprD in DRG， and up-regulating the protein expressions of Claudin-1 and Occludin in skin tissue.

Objective The aim of this study was to investigate the incidence and mortality of malignant tumors among urban residents in Yingkou City in 2021,and to explore the key points of prevention and treatment of malignant tumors.Methods Based on the cancer registration data of Yingkou urban area in 2021,the incidence,crude mortality,age-standardized incidence by Chinese standard population(ASIRC),age-standardized mortality by Chinese standard population(ASMRC),age-standardized incidence by world standard population(ASIRW),age-standardized mortality by world standard population(ASMRW),and the ranks of incidence and mortality of malignant tumors were calculated and analyzed.Results In 2021,the incidence of malignant tumors among urban ar-eas of Yingkou City was 475.86/100,000,ASIRC was 234.93/100,000 and ASIRW was 224.76/100,000.The top five most cancers by incidence were lung cancer,female breast cancer,colorectal cancer,thyroid cancer and gastric cancer.The crude mortality was 271.99/100,000;ASMRC was 118.42/100,000,and ASMRW was 115.80/100,000.The top five most cancers by mortality were lung cancer,colorectal cancer,liver cancer,breast cancer and pancreatic cancer.Both the incidence(x2=1,950.616,P＜0.001)and mortality(x2=2,283.237,P＜0.001)of malignant tumors increased with age,and reached the peak at the age of 80-84(incidence:1,619.35/100,000 and mortality:1,629.11/100,000).Conclusion Lung cancer,female breast cancer,colorectal cancer and thy-roid cancer are the key types of cancer that need to be focused on prevention and treatment in urban areas of Yingkou City;The elderly people are at a high-risk group for malignant tumors;Effective tertiary prevention measures should be comprehensively implemented for this high-risk populations to reduce the burden of malignant tumor diseases.

Aim To investigate the effect of angioten-sin Ⅱ type 1a receptor(AT1aR)knockout on cardiac dysfunction in rats with obesity and its possible molecu-lar mechanism.Methods SD rats(n=24)were used to generated the whole-body AT1 aR-deficiency rats by sgRNA and the CRISPR/Cas9 system,and the obesity model was constructed by feeding with high-fat diet(HFD).They were divided into four groups:wildtype(WT)and knockout(KO)groups with nor-mal feeding and their respective high-fat diets groups.Color ultrasound diagnostic instrument was uses to e-valuate the cardiac function;oil red O staining was a-dopted to stain the myocardial lipids;RT-PCR was used to detect the levels of GPX4 and Ptgs2 genes in myocardial tissue.Western blot was employed to detect the expression of GPX4,ferritin,Nrf2,HO-1 and NQO1 in rat myocardial tissue.ELISA and other kits were used to determine the lipid contents in serum and myocardium.Results It was found that high-fat feed-ing caused cardiac dysfunction,serum lipid disorders,oxidative stress and ferroptosis in SD rats.However,these changes were attenuated in AT1aR knockout rats fed with high-fat diet.Furthermore,compared with WT-HFD group,KO-HFD rats showed enhanced acti-vation of the Nrf2/HO-1 pathway in the myocardium,reduced ferroptosis,decreased lipid accumulation,and reduced cardiac dysfunction.Conclusion AT1aR knockout can improve HFD-induced cardiac dysfunc-tion by enhancing antioxidant capacity and reducing the degree of ferroptosis.

Objective:To develop and validate the Pain nursing Competency Evaluation Questionnaire for Nursing Students to provide an effective tool for measuring the pain management competency of nursing students in China.Methods:The questionnaire was constructed through literature review, semi-structured interviews, focus group discussions, Delphi expert consultation, and a pre-survey. From September 2023 to January 2024, a convenience sampling method was used to select 250 nursing students from Hangzhou Normal University and Lishui University in Zhejiang Province for the survey. Reliability and validity of the developed questionnaire were tested. A random sample of 30 nursing students was selected for retesting after two weeks.Results:A total of 10 female experts were consulted through correspondence. The Pain Care Competency Evaluation Questionnaire for nursing students consists of 36 items. Through exploratory factor analysis, five common factors were extracted: pain health education, comprehensive pain assessment, pain screening and assessment, analgesic interventions, and analgesic side effects nursing, which together explained 61.695% of the variance. The content validity of the questionnaire was 0.96, and the item-level content validity index ranged from 0.900 to 1.000. The overall Cronbach′s α coefficient was 0.924, and the Cronbach′s α coefficients for the five dimensions ranged from 0.856 to 0.915. The test-retest reliability was 0.831. Conclusions:The Pain Care Competency Evaluation Questionnaire for nursing students developed in this study has good reliability and validity. It can be used as a tool to assess nursing students′ competency in pain care and provides a reference for the design and optimization of pain care courses and clinical practice programs for nursing students in undergraduate institutions.

Objective:To evaluate the value of ultrasound radiomics combined with machine learning for early diagnosis of seronegative Hashimoto’s thyroiditis (SN-HT) .Methods:This retrospective study included 164 patients from Liaoning Provincial People’s Hospital , Lixin County People’s Hospital, Linghai Dalinghe Hospital, Fengcheng Phoenix Hospital, who underwent thyroidectomy for solitary nodules with normal thyroid function between Nov. 2016 and Jan. 2024. Postoperative pathology confirmed Hashimoto’s thyroiditis (HT) in some cases, who were further categorized into antibody-positive and antibody-negative groups based on serum antibody status. Patients without Hashimoto’s thyroiditis served as the control group. A total of 298 ultrasound images were analyzed. Radiomics features were extracted from hypoechoic non-nodular areas within 0.5 cm surrounding the tumor. Two senior pathologists and two senior ultrasound physicians independently assessed lymphocytic infiltration, eosinophilic changes of follicular epithelium, and the proportion of hypoechoic areas in pathology and ultrasound images, respectively. A machine learning model, CCH-NET, was developed using linear regression and t-distributed stochastic neighbor embedding (t-SNE) techniques. The dataset was divided into a training set (80%) and a validation set (20%) to compare the diagnostic accuracy of CCH-NET with that of senior ultrasound physicians. Results:In internal validation, CCH-NET achieved a diagnostic accuracy of 88.89% for both antibody-positive and antibody-negative groups, significantly higher than the 66.67% accuracy of senior ultrasound physicians ( P<0.01). In external validation, CCH-NET achieved 75.00% and 66.67% accuracy for the two groups, compared to 50.00% by senior ultrasound physicians. For the control group, both methods achieved 93.33% accuracy. The AUC of CCH-NET was 0.848, outperforming senior ultrasound physicians (0.681) ,demonstrating superior diagnostic performance. Conclusion:The radiomics-based CCH-NET model, using non-nodular hypoechoic areas as a specific indicator, can accurately identify early SN-HT in euthyroid patients. It significantly outperforms senior ultrasound physicians, improving diagnostic accuracy and reducing missed diagnoses.

Objective To explore the effect of total saponins of diaphragma juglandis fructus(DJF)on testicular function in rats and its possible mechanism.Methods Fifty SD male rats were randomly divided into NC group,MG model group(MG group),DJF low-dose group(LDJF group),DJF medium-dose group(MDJF group)and DJF high-dose group(HDJF group),with 10 rats in each group.The NC group was given daily subcutaneous injection of normal saline 500 mg/kg,and the other groups were given daily subcutaneous injection of D-galactose 500 mg/kg for 8 weeks to establish the subacute aging rat model.After 4 weeks of subcutaneous injection,rats of the LDJF group,MDJF group and HDJF group were given 100 mg/kg,200 mg/kg and 400 mg/kg DJF total saponin extract by gavage,respectively,and rats of the NC group and MG group were given 100 mg/kg normal saline by gavage,respectively,for 28 consecutive days.The body weight of rats in each group was measured,the testicular index and sperm parameters of rats in each group were analyzed,and the pathological changes of testicular tissue were observed.The serum levels of testosterone,oxidation factor superoxide dismutase(SOD)and malondialdehyde(MDA)in each group were detected.The expression of related proteins was detected by Western blot.Results Compared with the NC group,testicular weight,testicular index,serum testosterone and SOD levels,sperm density,sperm survival rate and sperm activity of rats in MG group were decreased,and MDA level of rats in MG group was increased;the protein expressions of Nrf2 and HO-1 in testicular tissue of rats in MG group were down-regulated,and the protein expressions of p53 and p21 in testicular tissue of rats in MG group were up-regulated,with statistically significant differences(P<0.05).Compared with the MG group,testicular weight,testicular index,serum testosterone and SOD levels,sperm density,sperm survival rate and sperm activity of rats in HDJF group were increased,and MDA level of rats in HDJF group was decreased;the protein expressions of Nrf2 and HO-1 in testicular tissue of rats in HDJF group were up-regulated,and the protein expressions of p53 and p21 in testicular tissue of rats in HDJF group were down-regulated,with statistically significant differences(P<0.05).There was no significant difference in the above indexes between LDJF group,MDJF group and MG group(P>0.05).Compared with the NC group,the arrangement of spermatogenic cells in testicular tissue was disordered,the number of spermatogenic cells was reduced,and the number of spermatozoa in seminiferous tubule was reduced in the MG group.Compared with the MG group,the testicular morphology was improved and the number of spermatozoa was increased after DJF total saponins intervention,and the improvement was most obvious in the HDJF group.Conclusion DJF total saponins can effectively ameliorate the decline of testicular functionin in rats,which may be related to activation of Nrf2/HO-1 pathway,enhancement of antioxidant stress level and inhibition of aging-related protein expression.

OBJECTIVE To establish a working model for the cough and asthma pharmaceutical care clinic and analyze the effects of outpatient pharmaceutical care interventions on patients.METHODS A pharmaceutical care clinic for cough and asthma was established in our hospital,with comprehensive regulations and rules,complete infrastructure and defined pharmaceutical care workflows.The demographic data of patients(gender,age,residence,disease duration and so on)were collected from May 2021 to December 2024.Indicators including health status,disease severity,inhalation technique,and medication adherence during visits and follow-up were collected and analyzed statistically,to assess the effects of pharmaceutical care interventions on patients.RESULTS The service procedure for the cough and asthma pharmaceutical care clinic in our hospital was established.A total of 215 patients'basic information was collected.It was found that among the patients,males accounted for 55.35%,with an average age of(60.91±15.75)years old.Patients aged 60 to 69 constituted the largest proportion at 28.37%,and they exhibited relatively poor medication adherence[with an average score of(5.64±1.76)].The majority of patients were diagnosed with chronic obstructive pulmonary disease(COPD)and prescribed budesonide/formoterol powder inhalers.In 68 follow-up cases,EQ-5D-5L scores increased by 5.81 points(P＜0.05);COPD Assessment Test(CAT)scores decreased by 4.05 points(P＜0.05),indicating reduced disease burden.Asthma Control Test(ACT)scores improved by 4.80 points,reaching partial control levels.Inhaler technique scores increased by 2.31 points(P＜0.05).Medication adherence scores rose by 1.09 points(P＜0.05).Patient satisfaction was over 90%.CONCLUSIONS After pharmaceutical care intervention,patients'health status,disease severity,inhalant use technique,and compliance have all improved,and their satisfaction with the cough and asthma pharmaceutical care outpatient service is high.The pharmaceutical care intervention provided by the cough and asthma pharmaceutical care outpatient service can improve patients'disease symptoms and medication compliance,and enhance the level of safe and rational drug use in the hospital.

Objective:To investigate the feasibility of varicocele ligation with mobile phone microscope.Methods:The high-performance mobile phone and mobile phone stand were combined to act as a mobile phone microscope.And the varicocele ligation was performed under the mobile phone microscope.Results:All five patients successfully underwent varicocelectomy under the guidance of a mobile phone microscope.The average operation time was(112.8±52.2)with ranged from 74.0 to 195.0 minutes.Three pa-tients completed the follow-up after the operation with the proportion of improved sperm quality reaching 100.0％(3/3).Conclusion:High-performance mobile phone microscope can be used for varicocele ligation.

Objective:To evaluate the clinical efficacy of Tianma Xionglin Zhixuan Tablets in treating hypertension patients with liver yang hyperactivity or comorbid phlegm-stasis syndrome and explore its therapeutic mechanisms through plasma metabolomics.Methods:Thirty-six hypertension patients(4 dropouts)diagnosed with liver yang hyperactivity or phlegm-stasis syndrome were enrolled as the treatment group from June 2022 to September 2023 at the First Affiliated Hospital of Hunan University of Chinese Medicine,while 30 healthy volunteers with balanced constitutions were recruited as the blank group.Plasma samples were collected from patients pre-and post-treatment and from healthy volunteers.Clinical outcomes,including syndrome scores,office blood pressure(BP),and 24-hour ambulatory BP,were recorded.Plasma metabolomic profiling was performed using liquid chromatography-mass spectrometry(LC-MS).Results:Compared with baseline,Tianma Xionglin Zhixuan Tablets significantly reduced traditional Chinese medicine syndrome scores(P＜0.01),office systolic/diastolic BP(P＜0.01),and 24-hour ambulatory BP parameters(24-hour mean BP,daytime/nighttime mean BP;all P＜0.01).Metabolomic analysis identified 45 differential metabolites between the blank group and pretreatment patients,and 64 metabolites altered post-treatment(VIP＞1,P＜0.05).Enrichment analysis of 16 overlapping endogenous metabolites revealed that Tianma Xionglin Zhixuan Tablets primarily modulated arachidonic acid metabolism and sphingolipid metabolism pathways.Conclusion:Tianma Xionglin Zhixuan Tablets demonstrates significant clinical efficacy in hypertension patients with liver yang hyperactivity or phlegm-stasis syndrome,potentially mediated through regulation of arachidonic acid and sphingolipid metabolism.