OBJECTIVE To explore the effect of bundled intervention measures on early infections in patients with malignant biliary obstruction(MBO)after intrabiliary stent implantation under the percutaneous transhepatic cholangial drainage(PTCD)route.METHOD Through convenience sampling method,37 patients with MBO ad-mitted to the First Affiliated Hospital of Fujian Medical University from Jan.2020 to Dec.2021 who received in-trabiliary stent implantation under the PTCD route were selected as the control group,43 patients admitted to the hospital from Jan.2022 to Dec.2023 who received the same procedure were selected as the study group,the control group received conventional infection prevention measures during the perioperative period,the study group added bundled inter-vention measures on this basis,and the postoperative infection status,white blood cell counts,C-reactive protein,and lowering levels of the two groups of patients.procalcitonin,blood amylase,blood lipase levels,hospitalization days and hospitalization costs between the two groups were compared.RESULTS The infection rate of the study group was 9.30％(4/43),lower than that of the control group(P=0.005).White blood cell counts,C-reactive protein,procalcitonin,blood amylase and blood lipase were elevated in both groups of patients on the first postoperative day,while the above in-dicators decreased in both groups of patients on the third postoperative day,with the study group lower than the control group.The hospitalization days in the study group was(7.33±2.55)days,lower than that in the control group(P＜0.001),the hospitalization cost of the study group was(20.32±3.70)thousand yuan,lower than that of the control group(P＜0.001).CONCLUSION Perioperative bundled measures can effectively reduce the risk of early infections in the patients with MBO after intrabiliary stent implantation under the PTCD route,decrease the occurrence of complications,shorten the length of hospital stay and reduce hospitalization costs.

BACKGROUND:Mitophagy is closely associated with the development of idiopathic pulmonary fibrosis,but its mechanism remains unclear.OBJECTIVE:To investigate the biological mechanism of mitophagy in idiopathic pulmonary fibrosis and provide ideas for the risk prediction of idiopathic pulmonary fibrosis and subtype differentiation.METHODS:The mitophagy-related genes in idiopathic pulmonary fibrosis were obtained through GEO and Reactome Pathway databases.The mitophagy-related characteristic genes in idiopathic pulmonary fibrosis were screened based on intergroup differences and random forest model.GO functional enrichment analysis and KEGG,Reactome with WIKI pathway enrichment analyses were performed by g:Profiler database.Mitophagy subtypes in idiopathic pulmonary fibrosis were distinguished by consensus clustering method and immune infiltration analysis was performed.The mitophagy-related key gene was screened.Finally,the predictive value of mitophagy-related key gene for the risk of idiopathic pulmonary fibrosis was quantified by alignment diagram and the correlation between mitophagy-related key gene and clinical characteristics of idiopathic pulmonary fibrosis was explored.RESULTS AND CONCLUSION:(1)A total of 13 genes related to mitophagy in idiopathic pulmonary fibrosis were identified and 5 characteristic genes were screened,containing PINK1,RPS27A,SRC,HIF1A,and CDH6.(2)GO analysis was mainly involved in ubiquitin protein ligase binding,and cellular response to hypoxia.Pathway enrichment analysis was mainly involved in PINK1-PRKN mediated mitophagy,NOTCH signaling pathway,signaling by EGFR and angiogenesis.(3)HIF1A had significant expression differences between subtypes,which might serve as a key gene for the differentiation of mitophagy subtypes of idiopathic pulmonary fibrosis.(4)Immune infiltration analysis suggested that myeloid-derived suppressor cell,neutrophil and type 1 T helper cell might have infiltration differences between subtypes,while HIF1A was positively correlated with multiple immune cells.(5)Alignment diagram suggested that the risk of idiopathic pulmonary fibrosis might be predicted by the expression level of HIF1A.(6)Clinical characteristics analysis indicated patients with high expression of HIF1A might have poorer lung function and more severe fibrosis.It is concluded that PINK1,RPS27A,SRC,HIF1A,and CDH6 may influence the development of idiopathic pulmonary fibrosis through mitophagy,in which HIF1A may serve as a key gene for risk prediction with clinical subtype differentiation and HIF1A is strongly associated with the lung function of patients.

Objective To observe the effect of rehabilitation nursing pathway in transjugular intrahepatic portosystemic shunt(TIPS).Methods From January 2022 to December 2024,160 patients with cirrhotic esopha-geal and gastric varices bleeding and intractable hydrothorax and ascites who underwent TIPS surgery were selected and randomly divided into path group and control group,with 80 cases in each group.The clinical treatment schemes of the two groups were consistent.The control group was given routine nursing,and the path group was intervened by rehabilitation nursing path model.Six-minute walking test(6 MWT)distance,Activity of Daily Living,ADL)scores,self-rating anxiety scale(SAS)and self-rating depression scale(SDS)scores,as well as the incidence of postoperative complications(hepatic encephalopathy and abdominal hemorrhage),hospitalization days,hospitalization expenses and nursing satisfaction scores were compared between the two groups.Results The incidence of postoperative complications in the pathway group was 6.25%(5/80),which was lower than that in the control group(16.25%,13/80).The 6MWT distance,ADL score,SAS score and SDS score in the path group were better than those in the control group,and the difference was statistically significant(P<0.05).The hospital-ization days in the path group were(10.50±2.50)days,which were shorter than those in the control group(12.70±3.50)days.The hospitalization expense was(8.31±0.71)million yuan,which was lower than that of the control group(8.92±0.53)million yuan.The nursing satisfaction score was(93.90±3.31),which was higher than that of the control group(89.50±4.21),and the difference was statistically significant(P<0.05).Conclusion TIPS rehabilitation nursing path can effectively promote patients'rehabilitation,reduce medical costs and improve patients'satisfaction.

OBJECTIVE To explore the effect of bundled intervention measures on early infections in patients with malignant biliary obstruction(MBO)after intrabiliary stent implantation under the percutaneous transhepatic cholangial drainage(PTCD)route.METHOD Through convenience sampling method,37 patients with MBO ad-mitted to the First Affiliated Hospital of Fujian Medical University from Jan.2020 to Dec.2021 who received in-trabiliary stent implantation under the PTCD route were selected as the control group,43 patients admitted to the hospital from Jan.2022 to Dec.2023 who received the same procedure were selected as the study group,the control group received conventional infection prevention measures during the perioperative period,the study group added bundled inter-vention measures on this basis,and the postoperative infection status,white blood cell counts,C-reactive protein,and lowering levels of the two groups of patients.procalcitonin,blood amylase,blood lipase levels,hospitalization days and hospitalization costs between the two groups were compared.RESULTS The infection rate of the study group was 9.30％(4/43),lower than that of the control group(P=0.005).White blood cell counts,C-reactive protein,procalcitonin,blood amylase and blood lipase were elevated in both groups of patients on the first postoperative day,while the above in-dicators decreased in both groups of patients on the third postoperative day,with the study group lower than the control group.The hospitalization days in the study group was(7.33±2.55)days,lower than that in the control group(P＜0.001),the hospitalization cost of the study group was(20.32±3.70)thousand yuan,lower than that of the control group(P＜0.001).CONCLUSION Perioperative bundled measures can effectively reduce the risk of early infections in the patients with MBO after intrabiliary stent implantation under the PTCD route,decrease the occurrence of complications,shorten the length of hospital stay and reduce hospitalization costs.

BackgroundThe professional self-concept of nurses is a crucial indicator for their personal growth， development and career planning. Previous studies have shown that work stressors during the internship period may lead to a decrease in the level of professional self-concept among nursing students. Given the existing differences in social roles between nursing students and clinical nurses， the influencing factors of professional self-concept in clinical nurses and its relationship with work stressors require further research. ObjectiveTo explore the relationship between work stressors and professional self-concept among nurses， so as to provide references for improving the level of professional self-concept of clinical nurses. MethodsFrom December 2022 to February 2023， a stratified random sampling method was employed to select 260 in-service nurses from Mianyang Hospital of Traditional Chinese Medicine as the study subjects. Chinese Nurses Stressor Scale （CNSS） and Professional Self-concept of Nurses Instrument （PSCNI） were used for assessment. Pearson correlation analysis was conducted to examine the correlation between CNSS scores and PSCNI scores of nurses. Multiple linear regression analysis was utilized to explore the factors influencing the professional self-concept of nurses. ResultsA total of 238 nurses （91.54%） completed valid questionnaires. PSCNI total score yielded a statistical difference among nurses with different marital statuses （F=8.947， P<0.05）. PSCNI total scores were significantly higher in nurses with emergency medical service experience than those without such experience （t=2.208， P<0.05）， and were significantly lower in nurses with abnormal physical examination findings in the past year than those without abnormal findings （t=-2.584， P<0.05）. Correlation analysis revealed that CNSS total score and subscale scores were negatively correlated with PSCNI total score （r=-0.275~-0.169， P<0.01）. Multiple linear regression analysis indicated that work expectation-related stressors， marital status and emergency medical service experience might be influencing factors of their professional self-concept （β=-0.350， 0.345， 0.183， P<0.01）. ConclusionNurses' work stressors are closely correlated with their professional self-concept， and high levels of stressors related to nurses' expectations may lead to a decrease in their professional self-concept levels. ［Funded by 2021 Research Project of Mianyang Municipal Health Commission （number， 202154）］

Objective:To investigate the clinical characteristics and survival outcomes of patients with nasopharyngeal carcinoma (NPC) complicated by multiple primary malignancies (MPCs) in a real-world setting.Methods:A retrospective study was performed on 238 NPC patients with MPCs who received radical radiotherapy at Fujian Cancer Hospital between January 1st, 2004 and December 31st, 2023. The primary endpoints were overall survival (OS) and cumulative survival rate. Survival analysis was conducted using the Kaplan-Meier method with log-rank / Breslow tests, and univariate analysis of prognostic factors was performed using the Cox proportional hazards model.Results:A total of 246 primary malignant tumors were identified in 238 patients, involving 12 organ systems and 39 tumor types. The most common coexisting malignancies occurred in the respiratory and intrathoracic organs [25.2% (62/246)], followed by digestive organ malignancies [22.8% (56/246)], malignancies of the lip, oral cavity, and pharynx [22.8% (56/246)], and thyroid and other endocrine gland malignancies [15.4% (38/246)]. The median OS was 186 months, and the 3-, 5-, and 10-year cumulative survival rates were 90.84%, 85.25%, and 69.45%, respectively. Poorer survival was associated with male sex, age>48 years at onset, locally advanced disease (stage IVA), synchronous MPCs and/or digestive system malignancies, fewer total cycles of chemotherapy, and lack of concurrent or adjuvant chemotherapy.Conclusions:In patients with NPC, MPCs most frequently involve the respiratory system, digestive system, and head and neck organs (including the thyroid). Male sex, older age, locally advanced primary NPC, synchronous and/or digestive system MPCs, fewer chemotherapy cycles, and lach of concurrent or adjuvant chemotherapy were significantly associated with poorer prognosis.

BACKGROUND:Mitophagy is closely associated with the development of idiopathic pulmonary fibrosis,but its mechanism remains unclear.OBJECTIVE:To investigate the biological mechanism of mitophagy in idiopathic pulmonary fibrosis and provide ideas for the risk prediction of idiopathic pulmonary fibrosis and subtype differentiation.METHODS:The mitophagy-related genes in idiopathic pulmonary fibrosis were obtained through GEO and Reactome Pathway databases.The mitophagy-related characteristic genes in idiopathic pulmonary fibrosis were screened based on intergroup differences and random forest model.GO functional enrichment analysis and KEGG,Reactome with WIKI pathway enrichment analyses were performed by g:Profiler database.Mitophagy subtypes in idiopathic pulmonary fibrosis were distinguished by consensus clustering method and immune infiltration analysis was performed.The mitophagy-related key gene was screened.Finally,the predictive value of mitophagy-related key gene for the risk of idiopathic pulmonary fibrosis was quantified by alignment diagram and the correlation between mitophagy-related key gene and clinical characteristics of idiopathic pulmonary fibrosis was explored.RESULTS AND CONCLUSION:(1)A total of 13 genes related to mitophagy in idiopathic pulmonary fibrosis were identified and 5 characteristic genes were screened,containing PINK1,RPS27A,SRC,HIF1A,and CDH6.(2)GO analysis was mainly involved in ubiquitin protein ligase binding,and cellular response to hypoxia.Pathway enrichment analysis was mainly involved in PINK1-PRKN mediated mitophagy,NOTCH signaling pathway,signaling by EGFR and angiogenesis.(3)HIF1A had significant expression differences between subtypes,which might serve as a key gene for the differentiation of mitophagy subtypes of idiopathic pulmonary fibrosis.(4)Immune infiltration analysis suggested that myeloid-derived suppressor cell,neutrophil and type 1 T helper cell might have infiltration differences between subtypes,while HIF1A was positively correlated with multiple immune cells.(5)Alignment diagram suggested that the risk of idiopathic pulmonary fibrosis might be predicted by the expression level of HIF1A.(6)Clinical characteristics analysis indicated patients with high expression of HIF1A might have poorer lung function and more severe fibrosis.It is concluded that PINK1,RPS27A,SRC,HIF1A,and CDH6 may influence the development of idiopathic pulmonary fibrosis through mitophagy,in which HIF1A may serve as a key gene for risk prediction with clinical subtype differentiation and HIF1A is strongly associated with the lung function of patients.

Objective:To investigate the clinical characteristics and survival outcomes of patients with nasopharyngeal carcinoma (NPC) complicated by multiple primary malignancies (MPCs) in a real-world setting.Methods:A retrospective study was performed on 238 NPC patients with MPCs who received radical radiotherapy at Fujian Cancer Hospital between January 1st, 2004 and December 31st, 2023. The primary endpoints were overall survival (OS) and cumulative survival rate. Survival analysis was conducted using the Kaplan-Meier method with log-rank / Breslow tests, and univariate analysis of prognostic factors was performed using the Cox proportional hazards model.Results:A total of 246 primary malignant tumors were identified in 238 patients, involving 12 organ systems and 39 tumor types. The most common coexisting malignancies occurred in the respiratory and intrathoracic organs [25.2% (62/246)], followed by digestive organ malignancies [22.8% (56/246)], malignancies of the lip, oral cavity, and pharynx [22.8% (56/246)], and thyroid and other endocrine gland malignancies [15.4% (38/246)]. The median OS was 186 months, and the 3-, 5-, and 10-year cumulative survival rates were 90.84%, 85.25%, and 69.45%, respectively. Poorer survival was associated with male sex, age>48 years at onset, locally advanced disease (stage IVA), synchronous MPCs and/or digestive system malignancies, fewer total cycles of chemotherapy, and lack of concurrent or adjuvant chemotherapy.Conclusions:In patients with NPC, MPCs most frequently involve the respiratory system, digestive system, and head and neck organs (including the thyroid). Male sex, older age, locally advanced primary NPC, synchronous and/or digestive system MPCs, fewer chemotherapy cycles, and lach of concurrent or adjuvant chemotherapy were significantly associated with poorer prognosis.

Objective To observe the effect of rehabilitation nursing pathway in transjugular intrahepatic portosystemic shunt(TIPS).Methods From January 2022 to December 2024,160 patients with cirrhotic esopha-geal and gastric varices bleeding and intractable hydrothorax and ascites who underwent TIPS surgery were selected and randomly divided into path group and control group,with 80 cases in each group.The clinical treatment schemes of the two groups were consistent.The control group was given routine nursing,and the path group was intervened by rehabilitation nursing path model.Six-minute walking test(6 MWT)distance,Activity of Daily Living,ADL)scores,self-rating anxiety scale(SAS)and self-rating depression scale(SDS)scores,as well as the incidence of postoperative complications(hepatic encephalopathy and abdominal hemorrhage),hospitalization days,hospitalization expenses and nursing satisfaction scores were compared between the two groups.Results The incidence of postoperative complications in the pathway group was 6.25%(5/80),which was lower than that in the control group(16.25%,13/80).The 6MWT distance,ADL score,SAS score and SDS score in the path group were better than those in the control group,and the difference was statistically significant(P<0.05).The hospital-ization days in the path group were(10.50±2.50)days,which were shorter than those in the control group(12.70±3.50)days.The hospitalization expense was(8.31±0.71)million yuan,which was lower than that of the control group(8.92±0.53)million yuan.The nursing satisfaction score was(93.90±3.31),which was higher than that of the control group(89.50±4.21),and the difference was statistically significant(P<0.05).Conclusion TIPS rehabilitation nursing path can effectively promote patients'rehabilitation,reduce medical costs and improve patients'satisfaction.

Arrhythmogenic cardiomyopathy (ACM), a fatal heart disease characterized by fibroadipocytic replacement of cardiac myocytes, accounts for 20% of sudden cardiac death and lacks effective treatment. It is often caused by mutations in desmosome proteins, with Desmoglein-2 (DSG2) mutations as a common etiology. However, the mechanism underlying the accumulation of fibrofatty in ACM remains unknown, which impedes the development of curative treatment. Here we investigated the fat accumulation and the underlying mechanism in a mouse model of ACM induced by cardiac-specific knockout of Dsg2 (CS-Dsg2 ^-/-). Heart failure and cardiac lipid accumulation were observed in CS-Dsg2 ^-/- mice. We demonstrated that these phenotypes were caused by decline of fatty acid (FA) β-oxidation resulted from impaired mammalian target of rapamycin (mTOR) signaling. Rapamycin worsened while overexpression of mTOR and 4EBP1 rescued the FA β-oxidation pathway in CS-Dsg2 ^-/- mice. Reactivation of PPARα by fenofibrate or AAV9-Pparα significantly alleviated the lipid accumulation and restored cardiac function. Our results suggest that impaired mTOR-4EBP1-PPARα-dependent FA β-oxidation contributes to myocardial lipid accumulation in ACM and PPARα may be a potential target for curative treatment of ACM.