Objective:To explore the focus points and emotional tendencies of cancer patients regarding medical services from their free-form comments, and to analyze the elements of perceived medical service value by patients.Methods:A tertiary general hospital in Shanghai invited patients to evaluate inpatient services through the assessment module of a patient satisfaction management platform, which included open-ended questions in the patient satisfaction survey. This study extracted free-form comment texts from cancer patients regarding medical services collected from September 2022 to August 2023 from this platform, forming a corpus of patient opinions. A hybrid method combining manual coding and natural language processing techniques was used to conduct sentiment analysis and topic modeling on the free-form comment texts. Descriptive analysis was performed on the comment themes and emotions, and logistic regression analysis was used to explore the relationship between patient negative comments and patient satisfaction and loyalty.Results:A total of 10 446 comment texts provided by cancer patients were included. The most frequently targeted objects in the comments were nurses (2 223 cases), followed by doctors (1 125 cases) and nursing assistants (162 cases). The results of sentiment analysis showed that 7 058 patients made positive comments, 1 958 patients made negative comments, 1 114 patients made neutral comments, and 316 patients made mixed comments. The results of topic analysis showed that the five most frequently mentioned themes by cancer patients were humanistic care (1 327 times), information provision, communication, and education (589 times), diet (582 times), effectiveness of diagnosis and treatment (506 times), and medical staff responsibility (489 times). Logistic regression analysis showed that negative evaluations of humanistic care ( OR=0.306, P<0.001), professional technical level ( OR=0.425, P=0.010), information provision, communication, and education ( OR=0.475, P<0.001), and response to needs ( OR=0.412, P=0.026) were significantly associated with decreased patient satisfaction. Negative evaluations of humanistic care ( OR=0.407, P<0.001), professional technical level ( OR=0.466, P=0.009), and information provision, communication, and education ( OR=0.557, P<0.001) were significantly associated with decreased patient loyalty. Conclusions:Hospital managers should value the role of patient free-form comment texts in improving medical services and make full use of natural language processing techniques for information mining. In addition, the results of this study show that patient comments mainly involve the interpersonal and functional aspects of service, especially the interpersonal interactions, which are often the " critical moments" for patients to critically evaluate hospital services during their service experience.

BackgroundFear of progression is one of the typical psychological consequences in patients with chronic obstructive pulmonary disease （COPD）. The level of fear of progression is affected by the illness perception status， and the link between social support and fear of progression is acknowledged， whereas the mechanism underlying the three remains unclear due to the lack of empirical research evidence and needs to be further studied. ObjectiveTo explore the mediating role of social support in the relationship between illness perception and fear of progression in COPD patients， and to provide references for effectively alleviating fear in COPD patients. MethodsA total of 435 COPD patients admitted to the Department of Respiratory and Critical Care Medicine， the Affiliated Hospital of Southwest Medical University from March 9 to July 31， 2024 were selected as the study objects. The Chinese version of Fear of Progression Questionnaire-Short Form （FoP-Q-SF）， Chinese version of Brief Illness Perception Questionnaire （BIPQ） and Social Support Rate Scale （SSRS） were used for the evaluation. Pearson's coefficient was calculated to assess the correlation among above scales. Model 4 of the Process macro 3.4.1 for SPSS 25.0 was used to test the mediating effect of social support on the relationship between illness perception and fear of progression， with Bootstrapping used to evaluate the significance of mediating effect. ResultsA total of 412 patients （94.71%） completed this study.BIPQ score was positively correlated with FoP-Q-SF score （r=0.238， P<0.01）， and negatively correlated with SSRS score in COPD patients （r=-0.260， P<0.01）. FoP-Q-SF score was negatively correlated with SSRS score （r=-0.271， P<0.01）. Social support mediated the relationship between illness perception and fear of progression， with an indirect effect value of 0.025 （95% CI： 0.009~0.041）， accounting for 13.02% of the total effect. ConclusionIllness perception can affect the fear of progression in COPD patients both directly and indirectly through social support. ［Funded by Nursing Research Project of Sichuan Province （number， H22010）］

To evaluate the efficacy and safety of dye-free submucosal injection solution for gastric endoscopic submucosal dissection (ESD), a retrospective cohort study was performed on data of inpatients with early gastric cancer and precancerous lesions who underwent ESD at the Digestive Endoscopy Center of Jiangsu Province Hospital of Traditional Chinese Medicine from January to December 2020. Cases were divided into dye-free submucosal injection solution group (the observation group) and dye-containing solution group (the control group). A total of 108 cases met the eligibility criteria for analysis (39 VS 69). Baseline characteristics were comparable between the two groups ( P>0.05). Compared with the control group, the observation group showed similar median procedure time (30.5 min VS 35.0 min), median dissection speed (0.3 cm2/min VS 0.4 cm2/min), mean volume of injection solution used (39.2 mL VS 38.8 mL), en bloc resection rate [100.0% (39/39) VS 98.6% (68/69)], and curative resection rate [97.4% (38/39) VS 97.1% (67/69)] (all P>0.05). Postoperative stay was 3.0±0.8 days in the observation group and 3.2±0.8 days in the control group ( t=-0.908, P=0.378). Delayed bleeding occurred in 3 (7.7%) patients VS 2 (2.9%) patients ( P=0.349), and postoperative infection occurred in 3 (7.7%) patients VS 8 (11.6%) patients ( P=0.743), respectively. In gastric ESD, dye-free submucosal injection solution demonstrates efficacy comparable with dye-containing solution and does not appreciably increase the incidence of intraoperative or postoperative complications.

Objective To explore the therapeutic effect of precise disconnection of pargastric varices guided by endoscopic ultrasound in the treatment of esophagogastric variceal bleeding.Method A retrospective analysis was conducted on 20 patients with cirrhosis esophagogastric variceal bleeding treated with endoscopic ultrasound-guided precise disconnection of pargastric varices from January 1,2024 to December 31,2024.The efficacy was analyzed.Result All 20 patients successfully completed the precise disconnection of pargastric varices under the guidance of endoscopic ultrasound.The injection of tissue gel combined with the placement of spring coils(14 cases)and the injection of tissue gel alone(4 cases)successfully blocked the pargastric varices.All patients did not experience perforation,esophageal and cardia stenosis,massive bleeding,septicemia,or ectopic embolization.One patient who received tissue gel alone had slight bleeding from the pargastric varices after surgery and improved after 3 days of treatment to reduce portal vein pressure.Another one patient who received tissue gel alone had a low-grade fever and normal body temperature after 3 days of anti-infection treatment.Conclusion Precise disconnection of pargastric varices under the guidance of endoscopic ultrasound has a good therapeutic effect on esophagogastric variceal bleeding,with fewer complications such as ectopic embolization,massive bleeding,infection,and perforation.However,close follow-up observation is still needed to address the issue of pargastric varices.

Objective To explore the therapeutic effect of precise disconnection of pargastric varices guided by endoscopic ultrasound in the treatment of esophagogastric variceal bleeding.Method A retrospective analysis was conducted on 20 patients with cirrhosis esophagogastric variceal bleeding treated with endoscopic ultrasound-guided precise disconnection of pargastric varices from January 1,2024 to December 31,2024.The efficacy was analyzed.Result All 20 patients successfully completed the precise disconnection of pargastric varices under the guidance of endoscopic ultrasound.The injection of tissue gel combined with the placement of spring coils(14 cases)and the injection of tissue gel alone(4 cases)successfully blocked the pargastric varices.All patients did not experience perforation,esophageal and cardia stenosis,massive bleeding,septicemia,or ectopic embolization.One patient who received tissue gel alone had slight bleeding from the pargastric varices after surgery and improved after 3 days of treatment to reduce portal vein pressure.Another one patient who received tissue gel alone had a low-grade fever and normal body temperature after 3 days of anti-infection treatment.Conclusion Precise disconnection of pargastric varices under the guidance of endoscopic ultrasound has a good therapeutic effect on esophagogastric variceal bleeding,with fewer complications such as ectopic embolization,massive bleeding,infection,and perforation.However,close follow-up observation is still needed to address the issue of pargastric varices.

Objective:To explore the focus points and emotional tendencies of cancer patients regarding medical services from their free-form comments, and to analyze the elements of perceived medical service value by patients.Methods:A tertiary general hospital in Shanghai invited patients to evaluate inpatient services through the assessment module of a patient satisfaction management platform, which included open-ended questions in the patient satisfaction survey. This study extracted free-form comment texts from cancer patients regarding medical services collected from September 2022 to August 2023 from this platform, forming a corpus of patient opinions. A hybrid method combining manual coding and natural language processing techniques was used to conduct sentiment analysis and topic modeling on the free-form comment texts. Descriptive analysis was performed on the comment themes and emotions, and logistic regression analysis was used to explore the relationship between patient negative comments and patient satisfaction and loyalty.Results:A total of 10 446 comment texts provided by cancer patients were included. The most frequently targeted objects in the comments were nurses (2 223 cases), followed by doctors (1 125 cases) and nursing assistants (162 cases). The results of sentiment analysis showed that 7 058 patients made positive comments, 1 958 patients made negative comments, 1 114 patients made neutral comments, and 316 patients made mixed comments. The results of topic analysis showed that the five most frequently mentioned themes by cancer patients were humanistic care (1 327 times), information provision, communication, and education (589 times), diet (582 times), effectiveness of diagnosis and treatment (506 times), and medical staff responsibility (489 times). Logistic regression analysis showed that negative evaluations of humanistic care ( OR=0.306, P<0.001), professional technical level ( OR=0.425, P=0.010), information provision, communication, and education ( OR=0.475, P<0.001), and response to needs ( OR=0.412, P=0.026) were significantly associated with decreased patient satisfaction. Negative evaluations of humanistic care ( OR=0.407, P<0.001), professional technical level ( OR=0.466, P=0.009), and information provision, communication, and education ( OR=0.557, P<0.001) were significantly associated with decreased patient loyalty. Conclusions:Hospital managers should value the role of patient free-form comment texts in improving medical services and make full use of natural language processing techniques for information mining. In addition, the results of this study show that patient comments mainly involve the interpersonal and functional aspects of service, especially the interpersonal interactions, which are often the " critical moments" for patients to critically evaluate hospital services during their service experience.

To evaluate the efficacy and safety of dye-free submucosal injection solution for gastric endoscopic submucosal dissection (ESD), a retrospective cohort study was performed on data of inpatients with early gastric cancer and precancerous lesions who underwent ESD at the Digestive Endoscopy Center of Jiangsu Province Hospital of Traditional Chinese Medicine from January to December 2020. Cases were divided into dye-free submucosal injection solution group (the observation group) and dye-containing solution group (the control group). A total of 108 cases met the eligibility criteria for analysis (39 VS 69). Baseline characteristics were comparable between the two groups ( P>0.05). Compared with the control group, the observation group showed similar median procedure time (30.5 min VS 35.0 min), median dissection speed (0.3 cm2/min VS 0.4 cm2/min), mean volume of injection solution used (39.2 mL VS 38.8 mL), en bloc resection rate [100.0% (39/39) VS 98.6% (68/69)], and curative resection rate [97.4% (38/39) VS 97.1% (67/69)] (all P>0.05). Postoperative stay was 3.0±0.8 days in the observation group and 3.2±0.8 days in the control group ( t=-0.908, P=0.378). Delayed bleeding occurred in 3 (7.7%) patients VS 2 (2.9%) patients ( P=0.349), and postoperative infection occurred in 3 (7.7%) patients VS 8 (11.6%) patients ( P=0.743), respectively. In gastric ESD, dye-free submucosal injection solution demonstrates efficacy comparable with dye-containing solution and does not appreciably increase the incidence of intraoperative or postoperative complications.

Objective To analyze the differential metabolites in the seminal plasma of different types of male infertility based on untargeted metabolomics and explore new biomarkers. Methods Seminal plasma samples were collected from 85 men,and divided into oligospermia (n=20),azoospermia (n=20),asthenozoospermia (n=10),high sperm DNA fragmentation index (n=15),and healthy control (n=20) groups. Seminal plasma metabolites were detected using liquid chromatography-mass spectrometry (LC-MS). Differential metabolites were identified after data processing and statistical analyses. Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis was used to identify key metabolic pathways. Area under the curve (AUC) was used to evaluate the diag-nostic efficacy of differential metabolites. Results We identified 1431 differential metabolites. KEGG enrichment analysis showed that differential metabolites mainly participated in pathways,such as amino acid biosynthesis,protein digestion and absorption,and nucleotide metabolism. The AUC of the top 10 upregulated and downregulated metabolites in each group were>0.7,indicating good diagnostic effi-cacy. Conclusion Untargeted metabolomics of seminal plasma can detect differential metabolites between different types of male infer-tility and healthy men,providing new ideas for exploring biomarkers and metabolomics-related mechanisms of male infertility.

OBJECTIVE To explore the mechanism of limonin treating in hepatic fibrosis through network pharmacology, and validate its mechanism by molecular docking and animal experiments. METHODS Firstly, the targets of limonin and hepatic fibrosis were screened from the SwissTargetPrediction, GeneCards and DisGeNet database, etc. Meanwhile, the common targets of limonin and hepatic fibrosis were obtained from the bioinformatics website. The protein protein interaction network of common target was constructed by using STRING database and Cytoscape software, and the CytoNCA plug-in was used to screen core targets. And then the enrichment analysis of GO and KEGG on the common target was performed by Metascape database. Thereby, the possible mechanism of limonin against hepatic fibrosis were predicted. Finally, the AutoDock Vina was used for molecular docking verification, and the prediction results of network pharmacology were verified by animal experiments. RESULTS The prediction results indicated that limonin might acted on 86 targets including AKT1, VEGFA and HIF1A, and participated in biological processes including hormone response, protein phosphorylation, angiogenesis, and PI3K-Akt pathway, HIF-1 pathway, VEGF pathway and other signaling pathways related to hepatic fibrosis. The results of protein protein interaction network topology analysis showed that the 11 core targets including AKT1, VEGFA, HIF1A and PIK3CA, etc. Molecular docking results showed that limonin had strong affinity and relatively stable binding conformation with the core targets. In the animal experiments, compared with the model group, hyaluronidase(HA) and laminin(LN) in rat serume in high-dose group of limonin(LH) and low-dose group of limonin(LL)(except for LN in LL group) were declined(P<0.01 or P<0.05), and the degree of inflammation and hepatic fibrosis were relieved to different degrees in liver tissue of the LH group and LL group; Western blotting and qPCR detection showed that protein and mRNA expression levels of AKT, HIF-1α and VEGF(except for VEGF in LL group) was down-regulated in the LH group and LL group(P<0.01 or P<0.05). CONCLUSION Limonin may acts on AKT1, VEGFA, HIF1A and other core targets to treat hepatic fibrosis angiogenesis, which may be related to the inhibition of AKT/HIF-1α/VEGF signaling pathway.

Objective:To assess the effectiveness of a 6-month Ba Duan Jin exercise program in improving the balance of community-dwelling older adults.Methods:A two arms, parallel-group, cluster randomized controlled trial was conducted in 1 028 community residents aged 60-80 years in 40 communities in 5 provinces of China. Participants in the intervention group (20 communities, 523 people) received Ba Duan Jin exercise 5 days/week, 1 hour/day for 6 months, and three times of falls prevention health education, and the control group (20 communities, 505 people) received falls prevention health education same as the intervention group. The Berg balance scale (BBS) score was the leading outcome indicator, and the secondary outcome indicators included the length of time of standing on one foot (with eyes open and closed), standing in a tandem stance (with eyes open and closed), the closed circle test, and the timed up to test.Results:A total of 1 028 participants were included in the final analysis, including 731 women (71.11%) and 297 men (28.89%), and the age was (69.87±5.67) years. After the 3-month intervention, compared with the baseline data, the BBS score of the intervention group was significantly higher than the control group by 3.05 (95% CI: 2.23-3.88) points ( P<0.001). After the 6-month intervention, compared with the baseline data, the BBS score of the intervention group was significantly higher than the control group by 4.70 (95% CI: 4.03-5.37) points ( P<0.001). Ba Duan Jin showed significant improvement ( P<0.05) in all secondary outcomes after 6 months of exercise in the intervention group compared with the control group. Conclusions:This study showed that Ba Duan Jin exercise can improve balance in community-dwelling older adults aged 60-80. The longer the exercise time, the better the improvement.