Objective:To investigate intraoperative pathological findings and the interventional effects of "deep cervical lymphaticovenous anastomosis+" (dcLVA+) on deep cervical lymphatic drainage as well as the blood flow of carotid artery and jugular vein in elderly patients with cognitive impairment, and to put forward the thoughts based on the findings from the surgery.Methods:Between May 2024 and December 2024, retrospective analysis of Microsurgery Hospital, Fengcheng Hospital, Xi'an Medical College performed dcLVA+ between the deep cervical lymphatics or lymph nodes and jugular veins in 50 elderly patients with cognitive impairment (19 males and 31 females, aged 55-88 years with 69.94 years in average). Nine patients were found with Clinical Dementia Rating (CDR) score at 1 (mild), 7 with CDR score at 2 (moderate) and 34 with CDR score at 3 (severe). Intraoperative observations based on literature reviews had identified anatomical relationships between the lymphatic sacs containing cervical lymphatic chain and the carotid sheath. The lymph node count, size, distribution, thickness of fat tissue and conditions of lymphatic vessels were documented. Ultrasound was used to compare the blood flow of carotid artery and jugular vein as well as the cross-sectional areas at the planes of hyoid and cricoid cartilage before and after the closure of incisions under anaesthesia in 39 patients. Correlation analyses for Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCa), Activities of Daily Living (ADL) and Agitation behavior score before and 1 week after surgery were performed using Spearman's correlation and Wilcoxon paired tests. P<0.05 was considered statistically significant. Postoperative follow-ups were conducted via the visit of outpatient clinic and WeChat and telephone interviews. Results:In surgery, the cervical lymphatic chain was found running within an almost enclosed sac surrounding the carotid sheath. There were enlarged lymph nodes, increased fat deposition, lymphatic dilation or fibrosis in the sac. The preoperative blood flow in the carotid artery at the planes of hyoid and cricoid cartilage in the 39 patients was recorded at 150.52 ml/min±40.33 ml/min and 358.29 ml/min±129.30 ml/min, while that in the jugular vein was at 172.50 ml/min±63.94 ml/min and 317.00 ml/min±105.21 ml/min, respectively, both were far lower than the normal blood flow. There were statistically significant differences in the blood flow of carotid artery and jugular vein before and after surgery ( P<0.01). It was found that the preoperative blood flow of the internal carotid artery at the plane of hyoid was positively correlated with the preoperative scores of MMSE ( P<0.01), MoCa ( P<0.05) and ADL ( P<0.01). The blood flow of the common carotid artery at the plane of cricoid cartilage was found significantly and positively correlated with the preoperative scores of MMSE ( P<0.05). It was also noted that the blood flow of the internal carotid artery at the plane of hyoid was significantly and positively correlated with the postoperative ADL ( P<0.01) but negatively correlated with the Agitation behavior score ( P<0.05). The blood flow of the common carotid artery at the plane of cricoid cartilage was significantly and positively correlated with the postoperative scores of MMSE and MoCa ( P<0.05). The blood flow of the internal jugular vein at the plane of hyoid was negatively correlated with the Agitation behavior score ( P<0.01). The cross-sectional area of carotid artery at the plane of left hyoid was significantly and positively correlated with the MMSE score ( P<0.05). Statistically significant differences were observed in MMSE, MoCa, ADL and Agitation behavior score before and after surgery ( P<0.01). Conclusion:dcLVA+ shows a certain therapeutic benefit to the elderly patients with cognitive impairment. The intraoperatively observed pathological changes in cervical lymphatic sacs affect deep cervical lymphatic drainage and the blood flow of carotid artery and jugular vein. Further studies are necessary to find out whether the findings from this study would be the specific pathological changes and the morbidity mechanisms among the elderly patients with cognitive impairment.

Objective:To investigate intraoperative pathological findings and the interventional effects of "deep cervical lymphaticovenous anastomosis+" (dcLVA+) on deep cervical lymphatic drainage as well as the blood flow of carotid artery and jugular vein in elderly patients with cognitive impairment, and to put forward the thoughts based on the findings from the surgery.Methods:Between May 2024 and December 2024, retrospective analysis of Microsurgery Hospital, Fengcheng Hospital, Xi'an Medical College performed dcLVA+ between the deep cervical lymphatics or lymph nodes and jugular veins in 50 elderly patients with cognitive impairment (19 males and 31 females, aged 55-88 years with 69.94 years in average). Nine patients were found with Clinical Dementia Rating (CDR) score at 1 (mild), 7 with CDR score at 2 (moderate) and 34 with CDR score at 3 (severe). Intraoperative observations based on literature reviews had identified anatomical relationships between the lymphatic sacs containing cervical lymphatic chain and the carotid sheath. The lymph node count, size, distribution, thickness of fat tissue and conditions of lymphatic vessels were documented. Ultrasound was used to compare the blood flow of carotid artery and jugular vein as well as the cross-sectional areas at the planes of hyoid and cricoid cartilage before and after the closure of incisions under anaesthesia in 39 patients. Correlation analyses for Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCa), Activities of Daily Living (ADL) and Agitation behavior score before and 1 week after surgery were performed using Spearman's correlation and Wilcoxon paired tests. P<0.05 was considered statistically significant. Postoperative follow-ups were conducted via the visit of outpatient clinic and WeChat and telephone interviews. Results:In surgery, the cervical lymphatic chain was found running within an almost enclosed sac surrounding the carotid sheath. There were enlarged lymph nodes, increased fat deposition, lymphatic dilation or fibrosis in the sac. The preoperative blood flow in the carotid artery at the planes of hyoid and cricoid cartilage in the 39 patients was recorded at 150.52 ml/min±40.33 ml/min and 358.29 ml/min±129.30 ml/min, while that in the jugular vein was at 172.50 ml/min±63.94 ml/min and 317.00 ml/min±105.21 ml/min, respectively, both were far lower than the normal blood flow. There were statistically significant differences in the blood flow of carotid artery and jugular vein before and after surgery ( P<0.01). It was found that the preoperative blood flow of the internal carotid artery at the plane of hyoid was positively correlated with the preoperative scores of MMSE ( P<0.01), MoCa ( P<0.05) and ADL ( P<0.01). The blood flow of the common carotid artery at the plane of cricoid cartilage was found significantly and positively correlated with the preoperative scores of MMSE ( P<0.05). It was also noted that the blood flow of the internal carotid artery at the plane of hyoid was significantly and positively correlated with the postoperative ADL ( P<0.01) but negatively correlated with the Agitation behavior score ( P<0.05). The blood flow of the common carotid artery at the plane of cricoid cartilage was significantly and positively correlated with the postoperative scores of MMSE and MoCa ( P<0.05). The blood flow of the internal jugular vein at the plane of hyoid was negatively correlated with the Agitation behavior score ( P<0.01). The cross-sectional area of carotid artery at the plane of left hyoid was significantly and positively correlated with the MMSE score ( P<0.05). Statistically significant differences were observed in MMSE, MoCa, ADL and Agitation behavior score before and after surgery ( P<0.01). Conclusion:dcLVA+ shows a certain therapeutic benefit to the elderly patients with cognitive impairment. The intraoperatively observed pathological changes in cervical lymphatic sacs affect deep cervical lymphatic drainage and the blood flow of carotid artery and jugular vein. Further studies are necessary to find out whether the findings from this study would be the specific pathological changes and the morbidity mechanisms among the elderly patients with cognitive impairment.

Objective:To identify the trajectory of fatigue-related symptom clusters(fatigue-decreased appetite-pain)in patients with lung cancer receiving immunotherapy and their influencing factors.Methods:From March 2022 to March 2023,114 patients with lung cancer receiving immunotherapy for the first time in Fudan University Shanghai Cancer Center were selected as research subjects.A 6-month longitudinal follow-up was performed using the PRO-CTCAE-based subset for lung cancer immunotherapy,and the demographic,disease physiological,psychological,social and healthy lifestyle data of patients were collected before the first dose.Growth mixed model and logistic regression analysis were used to identify the trajectory categories and influencing factors of fatigue-related symptom clusters.Results:Two fatigue trajectories of patients with lung cancer receiving immunotherapy were identified,named"mild to moderate fatigue persistent group"and"mild fatigue production-relief group".Three trajectories of decreased appetite were identified and named"decreased appetite aggravation group","mild decreased appetite maintenance group"and"decreased appetite exacerbation-relief group".Three trajectories of pain were identified,named"mild pain relief group","mild pain maintenance group"and"mild to moderate pain aggravation group".Logistic regression analysis showed that the age(OR=1.076,P=0.015)and targeted therapy(OR=10.743,P=0.009)were influential factors for fatigue.Duration of disease(OR=0.112,P=0.015),pemetrexed(OR=3.210,P=0.027)and targeted therapy(OR=7.077,P=0.032)were influential factors for pain.No influencing factors for decreased appetite have been identified.Conclusion:There is variability in the trajectory of symptom change in the fatigue-related symptom cluster in patients receiving immunotherapy for lung cancer.A small number of patients showed a trend of persistent worsening of appetite loss and pain.Future studies may continue to analyze intervention nodes based on symptom profile categories and help healthcare professionals identify key populations through influencing factors to provide personalized and holistic symptom management for patients with lung cancer receiving immunotherapy.

Objective:To identify the trajectory of fatigue-related symptom clusters(fatigue-decreased appetite-pain)in patients with lung cancer receiving immunotherapy and their influencing factors.Methods:From March 2022 to March 2023,114 patients with lung cancer receiving immunotherapy for the first time in Fudan University Shanghai Cancer Center were selected as research subjects.A 6-month longitudinal follow-up was performed using the PRO-CTCAE-based subset for lung cancer immunotherapy,and the demographic,disease physiological,psychological,social and healthy lifestyle data of patients were collected before the first dose.Growth mixed model and logistic regression analysis were used to identify the trajectory categories and influencing factors of fatigue-related symptom clusters.Results:Two fatigue trajectories of patients with lung cancer receiving immunotherapy were identified,named"mild to moderate fatigue persistent group"and"mild fatigue production-relief group".Three trajectories of decreased appetite were identified and named"decreased appetite aggravation group","mild decreased appetite maintenance group"and"decreased appetite exacerbation-relief group".Three trajectories of pain were identified,named"mild pain relief group","mild pain maintenance group"and"mild to moderate pain aggravation group".Logistic regression analysis showed that the age(OR=1.076,P=0.015)and targeted therapy(OR=10.743,P=0.009)were influential factors for fatigue.Duration of disease(OR=0.112,P=0.015),pemetrexed(OR=3.210,P=0.027)and targeted therapy(OR=7.077,P=0.032)were influential factors for pain.No influencing factors for decreased appetite have been identified.Conclusion:There is variability in the trajectory of symptom change in the fatigue-related symptom cluster in patients receiving immunotherapy for lung cancer.A small number of patients showed a trend of persistent worsening of appetite loss and pain.Future studies may continue to analyze intervention nodes based on symptom profile categories and help healthcare professionals identify key populations through influencing factors to provide personalized and holistic symptom management for patients with lung cancer receiving immunotherapy.

Objective To investigate maternal awareness and knowledge of obstructive sleep apnea syndrome (OSAS) and their compliance with polysomnography monitoring in snoring gravidas.Methods This study enrolled 589 volunteered gravidas who were treated at the 908th Hospital of Chinese People's Liberation Army Joint Logistic Support Force or Maternal and Child Health Hospital of Jiangxi Province from April 2016 to April 2017.The maternal knowledge of OSAS (0 point:complete lack of knowledge of OSAS;1 to 4 points:with partial knowledge of OSAS;5 points:correct understanding of OSAS) and the way of obtaining this knowledge were studied using a self-designed questionnaire.Influencing factors,including gestational weeks,educational background,snoring and high-risk pregnancy,were also analyzed.Chi-square test was used for statistical analysis.Results The 589 gravidas had few knowledge of OSAS and only 11 of them [1.9％ (11/589)] were able to fully understand OSAS (5 points).The proportion of women who were completely lack the knowledge of OSAS (0 point) in those less-educated women was higher than in those well-educated group [61.9％ (78/126) vs 52.0％ (241/463),x2=3.873,P=0.049].Among the gravidas who were unaware of their snoring condition,those completely lack the knowledge of OSAS (0 point) accounted for 67.0％ (209/312),which was higher than the percentage among gravidas knowing they had or did not have snoring problem [35.6％ (21/59),40.8％ (89/218);x2=20.755,35.687;both P＜0.017].There was no significant difference in OSAS awareness among gravidas regardless of their gestations and whether they were classified as high-risk or not (all P＞0.05).Of 59 gravidas with snoring,only 15 (25.4％) accepted polysomnography monitoring.Eight out of the 589 gravidas (1.4％) were diagnosed with OSAS during pregnancy.Conclusions Gravidas have poor knowledge and awareness of OSAS,especially those with low educational background and not knowing their snoring condition,resulting in poor compliance with polysornnography monitoring and low diagnostic rate of OSAS during pregnancy.

As the The Law of Traditional Chinese Medicine in People's Republic of China has been carried out, the gradual implementation and the development of traditional Chinese medicine apprentice education were increasing. This paper described the current situation and development of traditional Chinese medicine apprentice education.Based on the The Law of Traditional Chinese Medicine in People's Republic of China,the development and trendency of traditional Chinese medicine apprentice education in our country were explored, and the supporting foundation of policy of traditional Chinese medicine apprentice education were analyzed, in order to give some relevant suggestion.

Objective To evaluate the clinical significance of personalized biomechanical modeling of prostate deformation based on ultrasound elastography for magnetic resonance imaging(MRI)-transrectal ultrasound(TRUS)image registration.Methods A total number of 5 patients and 1 commercial prostate phantom were imaged via transrectal ultrasound elastography,3D-TRUS and MRI from June 2016 to December 2016.A personalized biomechanical model via the patient-specific ultrasound elastography was made for the deformable registration of prostate MRI and 3D-TRUS images.The registration accuracy was evaluated by the target registration error(TRE)and also the t-test was conducted to validate the statistical significance of our results.Results All the 5 sets of patient data as well as the phantom data were successfully registered.The TRE value of the phantom data was 1.65 mm.The mean TRE value of 5 patients was 1.31 mm,compared with the 2.52 mm TRE value of the registration method without patient-specific biomechanical properties via elastography,was approximately 48% lower(P <0.05).Conclusions Personalized biomechanical modeling of prostate deformation based on ultrasound elastography for MRI-TRUS image registration possesses important clinical significance and is a promising way to provide more quality guidance and improve the accuracy of prostate biopsy.

Objectives To investigate the correlation between dietary fatty acids intake of pregnant women and neonatal anthropometry at birth. Methods Women in early pregnancy were recruited with appropriate value of weight gain in pregnancy. Instant photography was used to assess the dietary situation in both the second trimester and the third trimester to calculate the intakes of food, energy, macronutrients, and fatty acids. The body weight, height and BMI at birth were evaluated with Z scores. The correlation between dietary fatty acids of pregnant women and neonatal anthropometry at birth were analyzed. Results There were 516 pregnant women recruited in this study. The average intakes of polyunsaturated fatty acids (PUFA) and the proportion of total fatty acids in the two trimesters were 15 . 09 g/d, 23 . 93% and 17 . 18 g/d, 24 . 86%. In the second trimester the intakes of n-6 and n-3 PUFA were 14 . 23 g/d and 3 . 45 g/d, and in the third trimester, n-6 and n-3 PUFA were 16 . 08 g/d and 3 . 81 g/d, the average intakes in the third trimester were signiifcantly higher than those in the second trimester (P??0 . 05 ). The intake of DHA ( 64 . 43 mg/d) in the second trimester was lower than that in the third trimester 75 . 12 mg/d, (P??0 . 05 ).The dietary intakes of n-3 PUFA, n-6 PUFA and n-6/n-3 ratio in the second trimester were positively correlated with neonatal BMI r=0 . 142~0 . 189 , P??0 . 05 ). Conclusions The dietary ratio of n-6/n-3 PUFA in the second trimester was positively correlated with neonatal BMI, suggesting that moderately increasing the intake of n-3 PUFA may play a positive role in reducing childhood obesity.