OBJECTIVE To construct a preoperative medication reconciliation model assisted by a localized large language model （LLM） for gastric cancer and evaluate its clinical efficacy. METHODS A total of 249 gastric cancer patients with a history of continuous medication before admission in the Gastric Surgery Department of Jiangsu Cancer Hospital were retrospectively enrolled. Patients were divided into training set （154 cases） and validation set （95 cases） based on the order of time. Based on guidelines， drug package inserts， and other evidence， a standardized medication reconcili ation process and a structured knowledge base were constructed. DeepSeek-V3 LLM was deployed privately in the hospital， combined with retrieval-augmented generation technology， to achieve automated integration of medication information， risk screening， and generation of personalized recommendations. The quality of LLM-generated recommendations was evaluated using automatic metrics （BERT Score and ROUGE-1， 2， L） and manual scoring [seven-dimensional index （7DI） ] . Spearman correlation analysis was performed to explore the correlation between automatic scores and manual scores. Cronbach’s α coefficient was used to test the internal consistency of manual scoring results. The time consumed by manual and LLM-assisted medication reconciliation was compared across tasks of different difficulty levels （simple， moderate， and high）. RESULTS A structured knowledge base covering 8 major drug categories was finally established， covering common and high-risk preoperative medication scenarios and providing structured retrieval support for the LLM. For automatic evaluation， the precision， recall， and F1-score of BERT Score were 0.783±0.033， 0.811±0.038， and 0.796±0.028， respectively. The F1-scores of ROUGE-1， ROUGE-2 and ROUGE-L were 0.566±0.067， 0.338±0.076 and 0.468±0.082， respectively. The 7DI scores from three manual raters ranged from 32.06 to 33.45. The F1-score of automatic scoring was significantly positively correlated with the 7DI score of manual scoring （maximum coefficient of determination＝0.611， P ＜0.001）， and the internal consistency of manual scoring was good （Cronbach’s α ＝ 0.876）. In terms of efficiency， LLM-assisted medication reconciliation reduced time consumption by more than 90% compared with manual reconciliation in the simple， moderate， and high-difficulty groups （ P ＜0.001）. CONCLUSIONS The medication reconciliation model constructed based on a localized LLM and structured knowledge base shows high accuracy， consistency， and clinical applicability in complex preoperative medication scenarios for gastric cancer. It can improve the efficiency of medication reconciliation and reduce potential medication risks.

Objective To investigate the impact of various health education intervention strategies on the proper use of personal respiratory protective equipment (RPE) among workers exposed to dust. Methods Dust-exposed workers were recruited from 60 selected enterprises in Guangdong Province using cluster random sampling method. They were randomly allocated to the control, low-intensity intervention, and high-intensity intervention groups, with 358, 346, and 371 workers in each group, respectively. Workers in the control group received no designed intervention. Workers in the low-intensity intervention group received traditional plus mobile health education on the proper use of RPE. Workers in the high-intensity intervention group received all components of the low-intensity intervention, supplemented with peer education. The intervention lasted for six months. RPE usage was compared among the three groups of workers before and after the intervention. Results Workers in the control, low-intensity intervention, and high-intensity intervention groups showed higher rates of both RPE wearing and correct RPE wearing after the intervention than before it within their respective groups (RPE wearing rate: 94.1% vs 99.2%, 95.7% vs 100.0%, 94.6% vs 100.0%, all P<0.01; correct RPE wearing rate: 66.8% vs 91.1%, 67.3% vs 95.7%, 66.6% vs 96.5%, all P<0.01). Post-intervention correct RPE wearing rates were highest in the high-intensity intervention group, followed by the low-intensity intervention group, and the control group, with the percentage of 96.50%, 95.66% and 91.06%, respectively (P<0.01). Binary logistic regression analysis result showed that different intervention strategies affected the correct use of personal RPE among dust-exposed workers after adjusting for gender, age, and other confounding factors (P<0.05). Compared with the control group, the rates of correct RPE use increased in the low-intensity intervention group and the high-intensity intervention group (odd ratio was 2.14 and 3.01; 95% confidence interval was 1.12 - 4.10 and 1.53 - 5.91, respectively). Conclusion The implementation of traditional plus mobile health education interventions on the proper use of RPE can promote correct RPE utilization among dust-exposed workers, and integrating peer education further enhances the intervention effectiveness.

Under the background of increasingly severe drug-resistant bacteria infections,protracted course of chronic wounds has become clinical difficulties disturbing both patients and doctors.With the unique advantages of broad antibacterial spectrum,low drug resistance rate and high safety,polyhexanide antibacterial agent has gradu-ally become a major approach for treatment and nursing of chronic wounds.The application of polyhexamethylene biguanide(PHMB)antimicrobial agents in treatment and nursing of chronic wounds was reviewed in the article,including the antibacterial properties,comparisons with other antimicrobial agents,actual clinical practice and potential side effects,aiming to guide the further application of PHMB antimicrobial agents in treatment of chronic wounds.

Objective:To retrospectively analyze the efficacy and safety of different radiotherapy doses in treating esophageal squamous carcinoma(ESCC)patients aged ≥80 years.Methods:This retrospective study collected clinical data from ESCC patients aged ≥80 years who underwent radiotherapy at the Fourth Hospital of Hebei Medical University from January 2016 to September 2021.Observation variables included overall survival(OS), progression free survival(PFS), complete response(CR), partial response(PR), stable disease(SD), progressive disease(PD), and adverse reactions.Survival rates were estimated using the Kaplan-Meier method and compared via log-rank tests.Cox regression models were employed for multivariate analysis.Results:A total of 165 patients who met the enrollment criteria were included in this study, including 88(88/165, 53.3%)males and 77(77/165, 46.7%)females, age 80 to 100 years(median age 83 years), 66 cases(66/165, 40.0%)in the radiotherapy dose ≥60 Gy group and 99 cases(99/165, 60.0%)in the <60 Gy group.Of the 165 patients, the effective rate was 71.5%(118/165).The median overall survival(OS)of the whole group was 19.0 months, The median Progression Free Survival(PFS)for the whole group was 13 months.The results showed that radiotherapy dose, lesion length, Nutritional Risk Index(NRI), eating condition, recurrence/progression and chemotherapy were factors influencing OS.The survival of patients in the ≥60 Gy group, ≤5 cm group, well-nourished group(NRI ≥45)group, soft diet and general diet group and combined chemotherapy group is better.Cox multivariate analysis revealed that radiotherapy, dose eating condition and the lesion length were independent prognostic factors for OS.The OS rate of the radiation therapy group with a dose of ≥ 60 Gy was better than that of the<60 Gy group( P=0.001), the OS of the general or soft diet group was better than that of the semi liquid or liquid diet group( P=0.008), and the OS of the lesion length ≤ 5 cm group was better than that of the>5 cm group( P=0.020).The incidence rates of radiation-induced esophagitis, myelosuppression, radiation pneumonia, and gastrointestinal reactions in the entire group were 60.0%(99/165), 12.1%(20/165), 22.4%(37/165), and 14.5%(24/165), respectively.51.5%(85/165)of the group experienced local recurrence, 10.3%(17/165)had distant organ metastasis, and 9.1%(15/165)had non regional lymph node metastasis.As of the follow-up date, there were a total of 99 deaths in the entire group. Conclusions:For patients aged 80 years or older with esophageal cancer, higher radiation doses, better feeding and nutritional status have more beneficial for prolonged survival.Local recurrence remains the main reason for treatment failure in elderly patients with esophageal cancer.

OBJECTIVE: To observe the effects of moxibustion at different temperatures on cognitive function and blood glucose levels in patients with cognitive impairment associated with type 2 diabetes mellitus (T2DM). METHODS: A total of 66 T2DM patients with cognitive impairment were randomly assigned to a high-temperature group (22 cases, 1 case dropped out, 1 case was eliminated), a medium-temperature group (22 cases, 2 cases were eliminated), and a low-temperature group (22 cases, 2 cases were eliminated). All groups received moxibustion at Baihui (GV20), Dazhui (GV14), and Shenting (GV24) based on their existing glycemic control treatment. Moxibustion temperatures were maintained at 44-46 ℃ (high-temperature group), 41-43 ℃ (medium-temperature group), and 38-40 ℃ (low-temperature group), respectively, for 20 min per session, every other day, 3 times a week for 3 months. The Montreal cognitive assessment (MoCA) score, mini-mental state examination (MMSE) score, short-term memory (STM) accuracy and average reaction time, Rey-Osterrieth complex figure (ROCF) score, fasting plasma glucose (FPG), and glycated hemoglobin (HbA1c) were assessed before and after treatment. Clinical efficacy was evaluated after treatment. RESULTS: After treatment, MMSE scores in all three groups were higher than those before treatment (P<0.05). In the high-temperature group, the total MoCA score and the scores of visuospatial and executive function, memory and delayed recall, attention, naming, language, and abstraction were higher than those before treatment (P<0.05); the scores of ROCF copy, immediate recall, and delayed recall were higher than those before treatment (P<0.05); the HbA1c level was lower than that before treatment (P<0.05). In the medium-temperature group, the total MoCA score and the scores of memory and delayed recall, attention, and language were higher than those before treatment (P<0.05). STM accuracy was higher than before treatment (P<0.05), and STM average reaction time was shorter than before treatment (P<0.05) in both the high-temperature and medium-temperature groups. After treatment, the total MoCA score and the scores of visuospatial and executive function, memory and delayed recall, attention, and language in the high-temperature group were higher than those in the medium- and low-temperature groups (P<0.05); MMSE score, STM accuracy, and ROCF immediate recall and delayed recall scores were higher than those in the medium- and low-temperature groups (P<0.05); STM average reaction time was shorter than that in the medium- and low-temperature groups (P<0.05); HbA1c level was lower than that in the low-temperature group (P<0.05). The total MoCA score, attention score, and MMSE score in the medium-temperature group were higher than those in the low-temperature group (P<0.05), and STM average reaction time was shorter than that in the low-temperature group (P<0.05). There were no statistically significant differences in FPG within or between the three groups before and after treatment (P>0.05). The total effective rates were 75.0% (15/20) in the high-temperature group, 50.0% (10/20) in the medium-temperature group, and 15.0% (3/20) in the low-temperature group; the total effective rate in the high-temperature group was significantly higher than that in the low-temperature group (P<0.05). CONCLUSION Moxibustion at different temperatures has a dose-effect relationship in treating cognitive impairment in T2DM patients. A temperature range of 44-46 ℃ is more effective in improving cognitive function and stabilizing average blood glucose levels over 2-3 months.
Humans ; Diabetes Mellitus, Type 2/therapy* ; Male ; Female ; Moxibustion ; Middle Aged ; Aged ; Cognitive Dysfunction/psychology* ; Cognition ; Temperature ; Blood Glucose/metabolism* ; Adult ; Acupuncture Points

Objective: To examine the reciprocal relationships of anxiety and depressive symptoms,uncertainty stress with academic buoyancy among college students, providing evidence for mental health promotion and academic resilience enhancement. Methods: A multi stage cluster random sampling method was used to selected 741 undergraduates from grade 1 to 2 of a university in Xuzhou, Jiangsu Province. Participants completed two waves of surveys (T1: October 2022; T2: October 2023) using the Uncertainty Stress Scale, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Academic Buoyancy Scale. Cross lagged models analyzed bidirectional relationships between three mental health variables and academic buoyancy, followed by latent variable modeling integrating all mental health dimensions. Results: Cross lagged model results revealed that T1 uncertainty stress negatively predicted T2 academic buoyancy ( β =-0.14), while T1 academic buoyancy negatively predicted T2 uncertainty stress ( β =-0.11); T1 depressive symptom negatively predicted T2 academic buoyancy ( β =-0.08), while T1 academic buoyancy negatively predicted T2 depressive symptom ( β =-0.09); furthermore, T1 academic buoyancy negatively predicted T2 anxiety symptom( β =-0.10) ( P <0.05). Results from the latent variable cross lagged model of psychological problems (constructed from the three mental health variables) indicated that T1 psychological problems negatively predicted T2 academic buoyancy ( β =-0.09), while T1 academic buoyancy negatively predicted T2 psychological problems ( β =-0.09) ( P <0.05). Conclusions Longitudinal bidirectional relationships exist between mental health status and academic buoyancy in college students. Better mental health facilitates higher academic buoyancy.

Objective To evaluate the application effect of perioperative cluster nursing interventions in patients under-going robot-assisted radical prostatectomy.Methods A total of 122 prostate cancer patients who underwent robot-assisted sur-gery from January 2023 to December 2024 were divided into the control group(routine care,55 cases)and the observation group(cluster nursing,67 cases)according to the nursing methods.The psychological status,surgery-related indicators,postoperative recovery,incidence of perioperative complications,and patient satisfaction were compared between the two groups.Results The observation group demonstrated a statistically significant decrease in postoperative anxiety and depression scores compared to the control group(P=0.034,P=0.005).The observation group exhibited shorter operative time and less intraoperative blood loss,with both differences being statistically significant(P=0.016,P＜0.001).In terms of postoperative recovery,the obser-vation group showed faster recovery of bowel function,shorter time for catheter insertion and postoperative hospital stay compared to the control group(P=0.010,P＜0.001,P＜0.001).In the observation group,the incidence of systemic postoperative in-fection was lower than that of the control group(4.5％vs 18.2％,P=0.015).The perioperative hypothermia rate in the obser-vation group was lower than that of the control group(38.8％vs 60.0％,P=0.020).There was no statistically significant difference in postoperative urinary fistula rate between the two groups(P=0.477).The observation group achieved an overall patient satisfaction rate of 98.51％,with higher satisfaction scores compared to the control group(P=0.008).Conclusion Perioperative cluster nursing measures yield favorable outcomes in patients undergoing robot-assisted radical prostatectomy.It can not only shorten the operation time,promote the postoperative recovery of patients,but also reduce the anxiety and depression of patients and complica-tions,and improve patient satisfaction.

Objective:To evaluate the feasibility and safety of open ventilation masks in patients with proliferative diabetic retinopathy (PDR) undergoing vitrectomy under local anesthesia.Methods:A randomized clinical trial was conducted.Eighty PDR patients (80 eyes) undergoing vitrectomy with local anesthesia were enrolled at Xuzhou Municipal Hospital from May to July 2024.Patients were randomly divided into an experimental group and a control group using a random number table method, with 40 cases (40 eyes) in each group.The experimental group received oxygen through an ophthalmic surgical open ventilation mask during the operation, while the control group used a traditional nasal cannula.The respiratory rate, heart rate, systolic blood pressure, diastolic blood pressure, and oxygen saturation before and after oxygen inhalation during the operation were compared between the two groups.Patient comfort level, airway patency, anxiety status, satisfaction level, operation time, surgical success rate, and incidence of intraoperative complications were also compared.This study adhered to the Declaration of Helsinki and the study protocol was appreed by the Ethics Committee of Xuzhou Municipal Hospital (No.2024-KY-065).Results:After oxygen inhalation during the operation, improvements in respiratory rate, heart rate, and oxygen saturation were greater in the experimental group than in the control group, with statistically significant differences ( t=4.671, 7.894, 1.588; all P<0.05).The Borg, and Hamilton Anxiety Scale scores were lower in the experimental group than in the control group, with statistically significant differences ( t=2.828, 4.880; both P<0.05), while the Bruggrmann Comfort Scale score was higher than that in the control group ( t=2.774, P<0.05).There were no statistically significant differences in operation time, surgical success rate or incidence of complications between the two groups ( t=0.595, P=0.554; χ2=0.346, 0.263; both P>0.05).Satisfaction rate of patients in the experimental group was 97.5%(39/40), which was higher than 85.0%(34/40) in the control group, with a statistically significant difference ( χ2=3.914, P=0.048). Conclusions:For PDR patients undergoing vitreous surgery under local anesthesia, using an ophthalmic surgical open ventilation mask for oxygen inhalation can effectively enhance respiratory comfort level, alleviate anxiety, maintain stable vital signs, improve overall comfort level, and ensure smooth surgery, without observed adverse reactions related to mask use, which makes it worthy of clinical promotion and application.

Objective:To search, evaluate, and summarize the best evidence of built-in fecal incontinence management device, to inform the management of incontinence dermatitis by clinical healthcare professionals.Methods:BMJ Best Practice, UpToDate, Guideline International Network, Joanna Briggs Institute, National Institute for Health and Care Excellence, Scottish Intercollegiate Guidelines Network, Registered Nurses′Association of Ontario, The Cochrane Library, Medline, Embase, SinoMed, CINAHL, PubMed, Web of Science, OVID, China National Knowledge Infrastructure, Wanfang Database were systematically searched for all evidence regarding the application of fecal collection devices. It included clinical practice, guidelines, systematic reviews, expert consensuses, evidence summaries, and randomized controlled trial. Two researchers independently evaluated the literature quality and extracted the literature that met the standards.Results:A total of 12 pieces of the literature were involved, including 2 best practice, 5 guidelines, 3 expert consensuses, and 2 systematic reviews. This study summarized 26 pieces of best evidence in relation to the following 5 themes: indications and contraindications, device insertion, device maintenance, device removal and effectiveness evaluation.Conclusions:This study scientifically and systematically summarized the best evidence regarding the insertion and maintenance of built-in fecal incontinence management device. We recommend that clinical practitioners integrate this evidence into their practice, while considering individual patient preferences and medical contexts. Adhering to individualization for evidence translation improves standardization and benefits patients in the clinical use of fecal collection devices.

Objective To explore the clinical effect of applying an improved"outside-in"technique in hip arthroscopic surgery.Methods Totally 136 patients undergoing hip arthroscopic surgery between June 2021 and July 2023 were selected and studied retrospectively.According to their different surgi-cal approach,they were divided into a modified approach group(n=75,including 30 males and 45 fe-males,with an average age of 36±14)and a classic approach group(n=61,including 33 males and 28 females,with an average age of 31±11).Before as well as 4 weeks,3 months and 6 months after the surgery,both groups were evaluated using the visual analog scale(VAS)and Harris hip score,and observed their surgical complications.Moreover,the surgical outcomes and time of sur-gical approach establishment were compared between the two groups.Results There was no significant difference between the two groups in general information,preoperative VAS and Harris scores.More-over,no significant difference was found between the two groups in the Harris score after surgery.Compared with the classic approach group,the improved group had significantly less surgical time(49.0±16.9 min vs.66.0±13.3 min,P<0.05),without using the C-arm fluoroscopy during surgery.Moreover,in the modified approach group,the time for establishing the mid-anteriorapproach was sig-nificantly shortened(10.4±5.9 min vs.25.9±15.1 min,P<0.05),along with the traction time during surgery(66.0±13.3 min vs.49.0±16.9 min,P<0.05).Conclusion The modified"outside-in"hip ar-throscopy technique is a safe and effective surgical method,easier to operate,with shorter surgical time.