Objective To explore the effect of enhanced recovery after surgery(ERAS)nursing combined with isokinetic muscle strength visual feedback training on postoperative patients with knee joint injury.Methods A total of 100 patients with knee joint injury who were treated in 909th Hospital(Southeast Hospital Affiliated of Xiamen University)from May 2022 to May 2023 were selected as the subjects.According to a random number table method,the patients were divided into control group(n=50)and observation group(n=50).The control group received ERAS nursing,and observation group received isokinetic muscle strength visual feedback training on the basis of control group.The pain,knee function recovery,quality of life and complications of two groups were compared.Results At 1 day,1 month,3 months and 6 months after operation,the pain visual analogue scale scores of observation group were lower than those of control group(P＜0.05).At 6 months after operation,the scores of knee joint function scale and World Health Organization quality of life scale in two groups were higher than before operation,and observation group were higher(P＜0.05).The total incidence of complications in observation group was lower than chat in control group(P＜0.05).Conclusion ERAS nursing combined with isokinetic muscle strength visual feedback training can significantly reduce postoperative pain in patients with knee joint injury,effectively promote the recovery of knee joint function.

Objective To explore the effect of enhanced recovery after surgery(ERAS)nursing combined with isokinetic muscle strength visual feedback training on postoperative patients with knee joint injury.Methods A total of 100 patients with knee joint injury who were treated in 909th Hospital(Southeast Hospital Affiliated of Xiamen University)from May 2022 to May 2023 were selected as the subjects.According to a random number table method,the patients were divided into control group(n=50)and observation group(n=50).The control group received ERAS nursing,and observation group received isokinetic muscle strength visual feedback training on the basis of control group.The pain,knee function recovery,quality of life and complications of two groups were compared.Results At 1 day,1 month,3 months and 6 months after operation,the pain visual analogue scale scores of observation group were lower than those of control group(P＜0.05).At 6 months after operation,the scores of knee joint function scale and World Health Organization quality of life scale in two groups were higher than before operation,and observation group were higher(P＜0.05).The total incidence of complications in observation group was lower than chat in control group(P＜0.05).Conclusion ERAS nursing combined with isokinetic muscle strength visual feedback training can significantly reduce postoperative pain in patients with knee joint injury,effectively promote the recovery of knee joint function.

Endometrial cancer (EC) is a common malignant tumor within the female reproductive system,and its incidence is increasing. The prognosis for patients with early EC is good,but the prognosis for patients with advanced and recurrent EC is extremely poor. In recent years,immune checkpoint inhibitors have shown significant promise in tumor therapy,including therapy for patients with advanced and re-current EC. Some of these patients experience disease progression during immunotherapy,and the mechanism of tumor immune escape is not thoroughly understood. Indoleamine 2,3-dioxyfenase-1 (IDO1) catalyzes the conversion of tryptophan to kynurenine,which is the first and rate-limiting step in the major pathway of tryptophan catabolism. IDO1 overexpression in a tumor microenvironment results in trypto-phan depletion and kynurenine metabolites overproduction,facilitating cancer immune escape. We review the primary mechanisms by which the IDO1 pathway facilitates immune escape in EC,and describe research progress into EC therapy targeting the IDO1 pathway.

Endometrial cancer (EC) is a common malignant tumor within the female reproductive system,and its incidence is increasing. The prognosis for patients with early EC is good,but the prognosis for patients with advanced and recurrent EC is extremely poor. In recent years,immune checkpoint inhibitors have shown significant promise in tumor therapy,including therapy for patients with advanced and re-current EC. Some of these patients experience disease progression during immunotherapy,and the mechanism of tumor immune escape is not thoroughly understood. Indoleamine 2,3-dioxyfenase-1 (IDO1) catalyzes the conversion of tryptophan to kynurenine,which is the first and rate-limiting step in the major pathway of tryptophan catabolism. IDO1 overexpression in a tumor microenvironment results in trypto-phan depletion and kynurenine metabolites overproduction,facilitating cancer immune escape. We review the primary mechanisms by which the IDO1 pathway facilitates immune escape in EC,and describe research progress into EC therapy targeting the IDO1 pathway.

Objective:To investigate and analyze the psychological stress status and influencing factors of medical staff in comprehensive grade A hospitals.Methods:This was a cross-sectional survey using a convenient sampling method. A questionnaire survey was conducted among 2 048 staff members of the Affiliated Hospital of Qingdao University from February 25 to June 16, 2022. The questionnaires included the Self-rating Stress Questionnaire (SSQ-53), the Self-rating Anxiety Scale, and the Self-rating Depression Scale. A total of 2 048 questionnaires were distributed and 2 048 were collected. Among them, 2 006 (97.95%) were valid questionnaires, and 2 006 medical staff were ultimately included in the analysis. According to the results of the scale, they were divided into the increased psychological stress group and the non increased psychological stress group. Descriptive analysis, independent sample t-test/chi-square test, correlation analysis, and other methods were used to analyze the psychological stress status of medical staff and the distribution of related factors, and multivariate logistic regression was used to analyze their influencing factors. Results:A total of 310 (15.5%) out of 2 006 study subjects showed increased psychological stress. Women had a statistically significant increase in physical (14.7% vs 8.0%, χ2=12.40, P<0.001) and emotional dimensions (18.2% vs 13.5%, χ2=5.04, P=0.025) of stress compared to men. The level of psychological stress was positively correlated with anxiety and depression ( r=0.810, 0.749, respectively, P<0.001). Univariate analysis showed that those who were women ( χ2=6.76, P=0.009), with low education backgrounds ( Z=-2.50, P=0.012), nurses ( χ2=15.72, P<0.001), or working in emergency departments ( χ2=13.64, P=0.009) had a higher rate of increased psychological stress, while the serum calcium level in the increased psychological stress group was lower than that in the non increased psychological stress group ( t=2.82, P=0.005). Multivariate analysis showed that low educational backgrounds ( OR=2.238, 95% CI: 1.090-4.597, P=0.028) and working in emergency department ( OR=1.589, 95% CI: 1.012-2.493, P=0.044) were independent risk factors for increased psychological stress of medical staff. Working in administrative and logistics departments ( OR=0.466, 95% CI: 0.229-0.950, P=0.036) and serum calcium level ( OR=0.213, 95% CI: 0.059-0.760, P=0.017) were negatively correlated with increased psychological stress. Conclusions:In comprehensive grade A hospitals, medical staff working in the emergency department or with lower educational backgrounds face greater psychological stress. Serum calcium level is negatively correlated with increased psychological stress, but the causal relationship needs further study.

Objective:To explore the current status of surgery for portal hypertension to grasp current status and future development of surgery in China.Methods:This study is jointly sponsored by China Hepatobiliary & Pancreatic Specialist Alliance & Portal Hypertension Alliance in China (CHESS).Comprehensive surveying is conducted for basic domestic situations of surgery for portal hypertension, including case load, surgical approaches, management of postoperative complications, primary effects, existing confusion and obstacles, liver transplantation(LT), laparoscopic procedures and transjugular intrahepatic portosystemic shunt(TIPS), etc.Results:A total of 8 512 cases of portal hypertension surgery are performed at 378 hospitals nationwide in 2021.Splenectomy plus devascularization predominated(53.0%)and laparoscopy accounted for 76.1%.Primary goal is preventing rebleeding(67.0%) and 72.8% of hospitals used preventive anticoagulants after conventional surgery.And 80.7% of teams believe that the formation of postoperative portal vein thrombosis is a surgical dilemma and 65.3% of hospitals practiced both laparoscopy and TIPS.The major reasons for patients with portal hypertension not receiving LT are due to a lack of qualifications for LT(69.3%)and economic factors(69.0%).Conclusions:Surgery is an integral part of management of portal hypertension in China.However, it is imperative to further standardize the grasp of surgical indications, the handling of surgical operation and the management of postoperative complications.Moreover, prospective, multi-center randomized controlled clinical studies should be performed.

Objective:To develop and validate a MRI-based radiomics nomogram combining with radiomics signature and clinical factors for the preoperative differentiation of benign parotid gland tumors (BPGT) and malignant parotid gland tumors (MPGT).Methods:From January 2015 to May 2020, 86 patients with parotid tumors confirmed by surgical pathology in the Affiliated Hospital of Qingdao University were enrolled as training sets, and 35 patients in the University of Hong Kong-Shenzhen Hospital from January 2013 to January 2020 were enrolled as independent external validation sets. The logistic regression was used to establish a clinical-factors model based on demographics and MRI findings. Radiomics features were extracted from preoperative T 1WI and fat-saturated T 2WI (fs-T 2WI), a radiomics signature model was constructed, and a radiomics score (Rad-Score) was calculated. A combined diagnostic model and nomogram combining with the Rad-score and independent clinical factors was constructed using multivariate logistic regression analysis. The receiver operating characteristic (ROC) analysis was used to evaluate the performance of each model and DeLong test was used for comparison of area under the ROC curve (AUC). Results:The logistic regression results showed that deep lobe involvement (OR=3.285, P=0.040) and surrounding tissue invasion (OR=15.919, P=0.013) were independent factors for MPGT and constructed the clinical-factors model. A total of 19 features were extracted from the joint T 1WI and fs-T 2WI to build the radiomics signature model. The combined diagnostic model and nomogram incorporating deep lobe involvement, surrounding tissue invasion and Rad-score were established. The AUCs of the clinical-factors model, radiomics signature model and combined diagnostic model for differentiating BPGT from MPGT for the training and validation sets were 0.758, 0.951, 0.953 and 0.752, 0.941 and 0.964 respectively. The AUCs of the radiomics signature model and the combined diagnostic model were significantly higher than those of the clinical-factors model for both training and validation sets (training set: Z=3.95, 4.31, both P<0.001; validation set: Z=2.16, 2.67, P=0.031, 0.008). There was no statistical difference in AUCs between the radiomics signature model and combined diagnostic model (training set: Z=0.39, P=0.697; validation set: Z=1.10, P=0.273). Conclusions:The MRI-based radiomics signature model and radiomics nomogram incorporating deep lobe involvement, surrounding tissue invasion, and Rad-score showed favorable predictive efficacy for differentiating BPGT from MPGT.

ObjectiveTo explore the differences of cognitive function in patients with treatment-resistant depression and drug-naive first-episode major depressive disorder， and to examine the relationship between severity of clinical symptoms and cognitive function， so as to provide references for prognosis improvement. MethodsFrom November 2016 to December 2019， 119 patients with drug-naive first-episode major depressive disorder and 82 patients with treatment-resistant depression in a hospital in Guangzhou were enrolled， meantime， another 71 healthy individuals recruited from the community were set as healthy control group. Clinical symptoms were assessed using Hamilton Depression Scale-17 item （HAMD-17） and Hamilton Anxiety Scale （HAMA）. Cognitive domains， including speed of processing， working memory， verbal learning and memory， and visual learning and memory were measured with the MATRICS Consensus Cognitive Battery （MCCB）. Multiple covariance analysis was used to compare the differences in cognitive function among three groups. Thereafter， partial correlation analysis was performed within patient groups to explore the relationship of HAMD-17/HAMA score with the four dimensions of MCCB. ResultsThe speed of processing， visual learning and memory scores of treatment-resistant depression group and drug-naive first-episode depression group were lower than those of healthy control group， and the working memory score of the treatment-resistant depression group was lower than that of the healthy control group， with statistical significance （P<0.05 or 0.01）. The speed of processing， visual learning and memory scores of treatment-resistant depression group were significantly lower than those of drug-naive first-episode depression group （P<0.05 or 0.01）. Partial correlation analysis within patient groups found that HAMD-17/HAMA total score had no correlation with the four dimensions of MCCB （P>0.05）. ConclusionCompared with drug-naive first-episode major depressive disorder patients and healthy controls， the impairments of speed of processing， visual learning and memory are more severe in patients with treatment-resistant depression. Moreover， the cognitive function impairment in patients with drug-naive first-episode major depressive disorder and treatment-resistant depression has no correlation with the severity of depressive and anxious symptoms.

Objective:To explore the curative effect of laparoscopic surgery for hepatic cysticercosis.Methods:Search the literature from February 2010 to February 2020 on literature platforms such as Wanfang Data, VIP, CNKI, Pubmed, ScienceDirect, Web of Science, etc. the key words were "肝囊型包虫病" , "细粒棘球蚴" , "手术" , "开腹手术" , "腹腔镜" , "微创手术" , " echinococcosis " , " liver or hepatic " , " laparoscopic or minimal invasive " . Data on intraoperative indicators (e.g., operation time, bleeding volume), postoperative complications, hospital stay, recurrence rate, etc. in the literature included in the study were extracted and meta-analyzed.Results:A total of 9 articles were included, including 2 prospective studies and 7 retrospective case-control studies. A total of 1031 patients were enrolled, including 272 in the laparoscopic group and 759 in the laparotomy group. The results of the meta-analysis showed that the total postoperative complication rate in the laparoscopic group was lower than that in the laparotomy group ( OR=1.64, 95% CI: 1.10-2.45, P<0.05). Incision-related complications in the laparoscopy group and laparotomy group the difference was statistically significant ( OR=2.81, 95% CI: 1.03-7.70, P<0.05), and the hospital stay in the laparoscopic group was shorter ( SMD=1.21, 95% CI: 0.47-1.96, P<0.05). There was no significant difference between the two groups in operation time, postoperative bile leakage, residual cavity infection and effusion, and postoperative recurrence rate ( P>0.05). Conclusions:Under the premise of strictly grasping the indication of laparoscopic surgery, the incidence of complications after laparoscopic surgery is low, the hospitalization time is short.

Objective:To evaluate the safety and efficacy of eltrombopag combined with immunosuppressive therapy in patients with aplastic anemia (AA) in China.Methods:We investigated and analyzed the clinical data of AA patients from 14 hematological treatment centers who were treated with oral eltrombopag for at least 3 mon.Results:We enrolled 56 AA patients, including 19 treatment-na?ve patients and 37 IST-refractory patients. The median administration period for eltrombopag was 7 (3-31) months, and the median maximum stable dosage was 75 mg/d (50-150 mg/d) . The 3-month hematological response (HR) rate was 60%, and the complete response (CR) rate was 30% in 10 SAA patients who were treated with first-line eltrombopag and standard IST (ATG+CsA) . Eight of 9 eltrombopag and CsA ± androgen first-line treated SAA patients responded (8/9, 89%) and 4 (44%) gave CR. The overall HR and CR rates were 79% and 52.6%, respectively, among these 19 patients by the end of the follow-up period. Of the 19 AA patients who were refractory to CsA ± androgen, 11 achieved HR (57.9%) at 3 mon, and the best HR rate was 44% in standard IST (ATG+CsA) refractory 18 patients after eltrombopag treatment. Fifty-one percent of the patients experienced mild or moderate adverse events, and gastrointestinal discomfort was the most common adverse effect reported by the study subjects.Conclusion:Adding Eltrombopag in first-line IST can accelerate the acquisition and improve the quality of hematological responses in AA patients. AA with relatively more residual hematopoietic cells may be well treated with eltrombopag and non-ATG IST. Eltrombopag can be used as salvage therapy for CsA±androgen refractory patients. Eltrombopag was generally safe and well tolerated by AA patients in China.