Objective To identify the key factors affecting the risk of medical surges and their coupling relation5 ships,providing strategic support for medical institutions to optimize risk management and emergency governance.Methods 17 influencing factors were determined based on WSR theory,and an expert scoring method was employed to assess the impact strength among the factors.The DEMATEL method was applied to calculate the centrality,cau5 sality,influence,and being influenced degrees of the influencing factors.The ISM method was used to construct a hierarchical structure of the influencing factors related to medical surge risks,thereby revealing the connections and interaction mechanisms among these factors.Results Seven critical influencing factors were identified,including the crisis decision-making capacity and leadership effectiveness of emergency managers,the completeness of the emer5 gency system and dynamic execution capabilities,and the cross-departmental coordination mechanism and com5 mand collaboration efficiency.Deep driving factors and coupling pathways were also revealed.Conclusion The risk of medical surges exhibits multi-factorial coupling cascade effects;attention should be directed towards the construc5 tion of mid-to-deep level mechanisms such as information systems,institutional frameworks,and organizational management,to enhance targeted capabilities and systemic resilience in risk governance.

Objective To define the conceptual connotation of network dynamic collaboration capacity in medical surge response and construct its theoretical model.Methods A mixed concept analysis method was employed,integrating multidisciplinary literature and collecting empirical evidence through semi-structured expert interviews to extract the concept of network dynamic collaboration capacity in medical surge response.By integrating complex systems,network science,synergetics,and dynamic capability theory,and combining the interview results,the study used the analogy of flood control in hydraulic engineering to develop a"network-dynamic-collaboration"triangular capacity theoretical model.Results It reveals one antecedents(sudden external shocks have led to an abnormal and continuous surge in medical demand),six core attributes(information interconnection accessibility,dynamic resource adaptability,risk perception responsiveness,multi-party collaborative interactivity,service process adaptability elasticity,and learning iterative evolution),and four consequences(mitigation of crowding risk,protection of service continuity,minimization of crisis spillover,and enhancement of system resilience)for the network dynamic collaboration capacity in medical surge response.The theoretical model elucidates the coupling mechanisms among network structural resilience,dynamic regulation processes,and collaborative co-evolution in resisting medical surge.Conclusion The new concept and theoretical model proposed in this study deepen the understanding of medical surge response system mechanisms and offer a theoretical framework and practical guidance for strengthening the full-chain resilience of health emergency systems.

Objective To empirically analyze multiple pathways for enhancing medical surge response capacity and provide useful references for improving the resilience of health systems.Methods A comprehensive theoretical analysis framework for improving medical surge response capacity was constructed based on the 4S theory and collaborative governance theory.68 interview texts on medical surge response capacity conducted in July 2024 were selected as analysis samples.Using fuzzy-set Qualitative Comparative Analysis(fsQCA),7 conditional variables were selected from four dimensions:management system,information system,materials,and personnel to analyze their impact on medical surge response capacity.Results(1)A single conditional variable does not constitute a necessary condition for improving medical surge response capacity;(2)After the combination of conditions,8 specific configuration paths for capacity improvement were identified.Through systematic and comprehensive refinement,they were summarized into three modes of comprehensive configuration capacity improvement paths,namely:rapid response and collaborative operation mode,information empowerment and precise response mode,and resource conditions and resilience construction mode.Conclusion It is necessary to explore and construct systematic,combined,modularized and path-oriented capacity building strategies,refine the operational implementation paths for improving China's medical surge response capacity,target the linkage and configuration modes of different conditional variables,promote the formulation and implementation of modular construction schemes oriented by key capacity,and make efforts from multiple aspects to enhance the resilience of the health system.

Objective To identify the key factors affecting the risk of medical surges and their coupling relation5 ships,providing strategic support for medical institutions to optimize risk management and emergency governance.Methods 17 influencing factors were determined based on WSR theory,and an expert scoring method was employed to assess the impact strength among the factors.The DEMATEL method was applied to calculate the centrality,cau5 sality,influence,and being influenced degrees of the influencing factors.The ISM method was used to construct a hierarchical structure of the influencing factors related to medical surge risks,thereby revealing the connections and interaction mechanisms among these factors.Results Seven critical influencing factors were identified,including the crisis decision-making capacity and leadership effectiveness of emergency managers,the completeness of the emer5 gency system and dynamic execution capabilities,and the cross-departmental coordination mechanism and com5 mand collaboration efficiency.Deep driving factors and coupling pathways were also revealed.Conclusion The risk of medical surges exhibits multi-factorial coupling cascade effects;attention should be directed towards the construc5 tion of mid-to-deep level mechanisms such as information systems,institutional frameworks,and organizational management,to enhance targeted capabilities and systemic resilience in risk governance.

Objective To define the conceptual connotation of network dynamic collaboration capacity in medical surge response and construct its theoretical model.Methods A mixed concept analysis method was employed,integrating multidisciplinary literature and collecting empirical evidence through semi-structured expert interviews to extract the concept of network dynamic collaboration capacity in medical surge response.By integrating complex systems,network science,synergetics,and dynamic capability theory,and combining the interview results,the study used the analogy of flood control in hydraulic engineering to develop a"network-dynamic-collaboration"triangular capacity theoretical model.Results It reveals one antecedents(sudden external shocks have led to an abnormal and continuous surge in medical demand),six core attributes(information interconnection accessibility,dynamic resource adaptability,risk perception responsiveness,multi-party collaborative interactivity,service process adaptability elasticity,and learning iterative evolution),and four consequences(mitigation of crowding risk,protection of service continuity,minimization of crisis spillover,and enhancement of system resilience)for the network dynamic collaboration capacity in medical surge response.The theoretical model elucidates the coupling mechanisms among network structural resilience,dynamic regulation processes,and collaborative co-evolution in resisting medical surge.Conclusion The new concept and theoretical model proposed in this study deepen the understanding of medical surge response system mechanisms and offer a theoretical framework and practical guidance for strengthening the full-chain resilience of health emergency systems.

Objective To empirically analyze multiple pathways for enhancing medical surge response capacity and provide useful references for improving the resilience of health systems.Methods A comprehensive theoretical analysis framework for improving medical surge response capacity was constructed based on the 4S theory and collaborative governance theory.68 interview texts on medical surge response capacity conducted in July 2024 were selected as analysis samples.Using fuzzy-set Qualitative Comparative Analysis(fsQCA),7 conditional variables were selected from four dimensions:management system,information system,materials,and personnel to analyze their impact on medical surge response capacity.Results(1)A single conditional variable does not constitute a necessary condition for improving medical surge response capacity;(2)After the combination of conditions,8 specific configuration paths for capacity improvement were identified.Through systematic and comprehensive refinement,they were summarized into three modes of comprehensive configuration capacity improvement paths,namely:rapid response and collaborative operation mode,information empowerment and precise response mode,and resource conditions and resilience construction mode.Conclusion It is necessary to explore and construct systematic,combined,modularized and path-oriented capacity building strategies,refine the operational implementation paths for improving China's medical surge response capacity,target the linkage and configuration modes of different conditional variables,promote the formulation and implementation of modular construction schemes oriented by key capacity,and make efforts from multiple aspects to enhance the resilience of the health system.

Objective:To investigate the clinical value of peripheral blood T lymphocytes in the diagnosis and prognosis of patients with hepatocellular carcinoma (HCC) recurrence after liver transplantation.Methods:The clinical and laboratory data of 50 HCC patients, who received liver transplantation and were followed up in the Liver transplantation Center of Beijing Youan Hospital from January 2014 to December 2016, were retrospectively analyzed. The differences on clinical laboratory indicators and five-year survival were compared between HCC recurrence group ( n=29) and non-recurrence group ( n=21). Spearman correlate analysis was used to analyze the correlation between clinical laboratory indicators and HCC recurrence after liver transplantation. Receiver operator characteristic (ROC) curve was used to analyze the diagnostic value of CD4+T lymphocytes in HCC recurrence after liver transplantation. Kaplan-Meier survival curve was used to compare the survival time of patients with different CD4+T lymphocytes levels post liver transplantation. Results:Compared to non-recurrence group, the level of alanine aminotransferase, aspartate aminotransferase, γ-glutamyltransferase, albumin, lymphocytes, alpha-fetoprotein, protein induced by vitamin K deficiency or antagonist-Ⅱ, CD3+, CD4+and CD8+T lymphocytes were significantly different (all P<0.05). The median recurrence time after liver transplantation was 13.0 (6.0, 24.0) months, and the mortality rate was 100%. The 5-year mortality rate was 0 in the non-recurrence group. During 5-year follow-up, the median survival time of patients in the HCC recurrence group was 18.0 (9.0, 36.0) months, which was significantly lower than that of non-recurrence group [60.0 (60.0, 60.0) months, ( P<0.05)]. Compared with non-recurrence group, the CD3+, CD4+, and CD8+T lymphocytes were significantly lower in the recurrence group (all P<0.05). Spearman correlate analysis showed that HCC recurrence after liver transplantation was negatively correlated with the CD3+, CD8+and CD4+T lymphocytes ( r=-0.43, -0.38, -0.44, all P<0.05). ROC analysis showed that CD4+T lymphocytes at cutoff of≤265.50 cells/μl was valuable for the diagnosis of HCC recurrence after liver transplantation (specificity 100%, sensitivity 48.30%). Survival curve analysis showed that the survival time was significantly lower in the CD4≤265.50 cells/μl group [15.0 (10.0, 36.8) months] than that in the CD4>265.50 cells/μl group [53.0 (19.5, 60.0) months] ( P<0.05). Conclusion:There is a significant negative correlation between CD4+T lymphocytes and HCC recurrence after liver transplantation. CD4+T lymphocytes at cutoff value of≤265.50 cells/μl is valuable for the clinical diagnosis and prognosis evaluation of HCC recurrence after liver transplantation.

Objective:To explore the effects of occupational and recreational therapy on symptom distress and mental toughness in perioperative period for lung neoplasms patients.Methods:By adopt convenient sampling method, a total of 92 cases of lung tumor patients were collected the lung cancer department in Tianjin Medical University Cancer Institute & Hospital from December 2019 to September 2020 in pulmonary oncology department. They were divided into observation group and control group according to the order of admission, with 46 cases in each group. The patients in the control group received routine care, the observation group implemented occupational and recreational therapy based on the routine care. At enrollment and 1 month after discharge, the effects were assessed by Chinese Version of the MD Anderson Symptom Inventory (MDASI-C) and Connor-Davidson Resilience scale (CD-RISC), respectively.Results:After intervention, the symptom distress scores and life influence scores in MDASI-C were (4.45 ± 1.09) points and (5.24 ± 1.78) points in the observation group, significantly lower than in the control group (5.84 ± 1.67) points and (6.11 ± 1.32) points, the differences were statistically significant ( t=4.59, 2.59, both P<0.05); the scores of tenacity, power, optimism and total scores of CD-RISC in the observation group were (28.12 ± 4.39) points, (21.07 ± 5.57) points, (10.67 ± 3.03) points and (59.86 ± 8.29) points, significantly higher than in the control group (24.54 ± 4.16) points, (18.23 ± 4.21) points, (9.16 ± 2.47) points and (51.93 ± 5.99) points, the differences were statistically significant ( t values were 2.53-5.10, all P<0.05). Conclusions:Occupational and recreational therapy can effectively alleviate symptom distress and promote mental toughness of lung cancer patients in perioperative period.

Objective:To analyze the characteristics of colonoscopy in patients aged 75 and above.Methods:The clinical data of 216 elderly patients aged 75 and above undergoing colonoscopy in our hospital from August 2015 to June 2019 were retrospectively analyzed. According to WHO criteria, there were 140 cases in aged group (75 to 89 years old) and 76 cases in the advanced aged group (90 years old and over). Demographic data, colonoscopy completion rate, bowel preparation quality, positive diagnosis rate and adverse events were analyzed and compared between the two groups.Results:More colonoscopies were performed under general anesthesia [7.9% (6/76) vs. 1.4% (2/140), χ 2=5.775, P<0.05] in the advanced aged group compared to the aged group, and the advanced aged group received lower doses of propofol and fentanyl when colonoscopies were administered with moderate sedation [(69.0±37.4) mg vs.(100.8±34.3)mg, t=6.302, P<0.01; (57.5±31.2) μg vs. (84.0±28.6)μg, t=6.297, P<0.01]. Colonoscopy completion was lower in the advanced aged group than that in the aged group[88.2%(67/76) vs. 99.3% (139/140), χ 2=13.815, P<0.01] and bowl preparation quality was worse [31.6%(24/76) vs. 15.0% (21/140), χ 2=8.209, P<0.05]. The proportion of adverse cardiopulmonary events [5.3%(4/76) vs. 0 (0/140), χ 2=7.507, P<0.01] and overall adverse events [9.2% (7/76) vs. 0.7% (1/140), χ 2=9.970, P<0.01] were higher in the advanced aged group than those in the elderly group. Colorectal cancer [14.5% (11/76) vs. 2.1% (3/140), χ 2=12.357, P<0.01] and advanced adenoma [27.6% (21/76) vs. 6.4% (9/140), χ 2=18.516, P<0.01] were more common in the advanced aged group than those in the aged group. Conclusion:Compared with the patients aged 75-89 years, patients aged 90 years and above have lower percentage of colonoscopy completion, lower quality of bowl preparation, and higher incidence of adverse events, and higher percentage of colorectal cancer and advanced adenomas detected.

OBJECTIVE：To optimize the extractio n technology of Fritillaria pallidiflora polysaccharides（FPSP），and to study its structure. METHODS ：Using the yield of FPSP as response value ，Box-Behnken design-response surface methodology was adopted to optimize solid-liquid ratio ，extraction temperature and extraction time of FPSP extraction technology. Structural properties of FPSP was characterized by UV spectrum ，FTIR，GC-MS，Congo red staining ，SEM，XRD and thermogravimetric analysis. RESULTS：The optimal technology parameters of FPSP were solid-liquid ratio of 1∶28（g/mL），extraction temperature of 94 ℃， extraction time of 2.5 h；the yield of FPSP was 16.25％（n＝3），the error of which to theoretical yield （16.58％）was 0.33％. FPSP contained xylose ，glucose and galactose with a molar ratio of 1∶58.02∶0.73，and trace amount of mannose ；there was a weak absorption peak near the wavelength of 280 nm；belonged to α-configuration pyranopolysaccharide. FPSP was in triple-helical structure. The surface of FPSP was a network structure formed by irregular particles. FPSP had both crystalline and amorphous structures. FPSP had good thermostability. CONCLUSIONS ：The optimized extraction technology of FPSP is reasonable ，and has high extraction yield. The research might provide reference for the further development and utilization of F. pallidiflora .