Objective:To explore the mediating effect of self-compassion between post-traumatic stress disorder (PTSD) and posttraumatic growth (PTG) in patients with ischemic stroke (IS) .Methods:From January 2021 to March 2024, convenience sampling was used to select 165 first-episode IS patients from Xinxiang Central Hospital as research subjects. General Information Questionnaire, Self-Compassion Scale (SCS), Posttraumatic Stress Disorder Checklist-Civilian Version (PCL-C), and Post-Traumatic Growth Inventory (PTGI) were used for the survey. The mediating effect of self-compassion between PTSD and PTG was analyzed.Results:A total of 165 questionnaires were distributed and 162 were collected, with a response rate of 98.18%. The total scores of SCS, PCL-C, and PTGI in 162 patients with ischemic stroke were (74.53±10.78), (33.94±9.27), and (56.77±8.33), respectively. Mediating analysis showed that self-compassion partially mediated PTSD and PTG in patients with ischemic stroke ( P<0.01) . Conclusions:Self-compassion plays a partial mediating role in PTSD and PTG in patients with ischemic stroke. Medical and nursing staff should pay attention to improving patients' self-compassion, reducing stress disorders, and promoting PTG.

Objective:To investigate the plasma level of interleukin(IL)-37 and assess its regulatory effects on monocyte activity in type 1 diabetes mellitus(T1DM) patients.Methods:This prospective study included 57 T1DM patients and 21 healthy controls who were continuously enrolled from December 2022 to January 2024 at Xinxiang Central Hospital. Plasma and peripheral blood mononuclear cells were isolated. IL-37 and soluble interleukin 1 receptor 8(IL-1R8) levels were measured by enzyme-linked immunosorbent assay(ELISA). Levels of IL-37 receptor subunits in monocytes were analyzed via flow cytometry. Purified monocytes were stimulated with recombinant IL-37 and co-cultured with a human pancreatic β-cell line to assess cytotoxicity, measured by target cell death and cytokine levels. Additionally, monocytes were co-cultured with autologous CD4 + T cells to evaluate antigen presentation by measuring interferon-γ(IFN-γ) and IL-17A secretion. Results:Plasma IL-37 level and IL-37 receptor subunit expression in monocytes were significantly lower in T1DM patients compared to controls(both P<0.001). However, there was no significant difference in soluble IL-1R8 levels between the groups( P=0.457). Monocytes from T1DM patients exhibited increased cytotoxicity, as indicated by higher target cell death and elevated levels of granzyme A, granzyme B, granzyme H, IL-1β, IL-6, and tumor necrosis factor-α( P<0.05). Additionally, monocyte-induced secretion of IFN-γ and IL-17A by CD4 + T cells was elevated in T1DM patients(all P<0.05). Stimulation of T1DM monocytes with recombinant IL-37 reduced target cell death and decreased granzyme B secretion compared to unstimulated monocytes(both P<0.05). However, IL-37 stimulation had no significant effect on other cytokine levels or monocyte-induced IFN-γ and IL-17A secretion( P>0.05). Conclusions:Monocytes exhibit enhanced cytotoxicity and antigen-presenting capacity in T1DM patients. IL-37 reduces monocyte cytotoxicity by inhibiting granzyme B secretion, but does not affect antigen presenting function in T1DM.

Objective:To explore the mediating effect of self-compassion between post-traumatic stress disorder (PTSD) and posttraumatic growth (PTG) in patients with ischemic stroke (IS) .Methods:From January 2021 to March 2024, convenience sampling was used to select 165 first-episode IS patients from Xinxiang Central Hospital as research subjects. General Information Questionnaire, Self-Compassion Scale (SCS), Posttraumatic Stress Disorder Checklist-Civilian Version (PCL-C), and Post-Traumatic Growth Inventory (PTGI) were used for the survey. The mediating effect of self-compassion between PTSD and PTG was analyzed.Results:A total of 165 questionnaires were distributed and 162 were collected, with a response rate of 98.18%. The total scores of SCS, PCL-C, and PTGI in 162 patients with ischemic stroke were (74.53±10.78), (33.94±9.27), and (56.77±8.33), respectively. Mediating analysis showed that self-compassion partially mediated PTSD and PTG in patients with ischemic stroke ( P<0.01) . Conclusions:Self-compassion plays a partial mediating role in PTSD and PTG in patients with ischemic stroke. Medical and nursing staff should pay attention to improving patients' self-compassion, reducing stress disorders, and promoting PTG.

Objective:To investigate the plasma level of interleukin(IL)-37 and assess its regulatory effects on monocyte activity in type 1 diabetes mellitus(T1DM) patients.Methods:This prospective study included 57 T1DM patients and 21 healthy controls who were continuously enrolled from December 2022 to January 2024 at Xinxiang Central Hospital. Plasma and peripheral blood mononuclear cells were isolated. IL-37 and soluble interleukin 1 receptor 8(IL-1R8) levels were measured by enzyme-linked immunosorbent assay(ELISA). Levels of IL-37 receptor subunits in monocytes were analyzed via flow cytometry. Purified monocytes were stimulated with recombinant IL-37 and co-cultured with a human pancreatic β-cell line to assess cytotoxicity, measured by target cell death and cytokine levels. Additionally, monocytes were co-cultured with autologous CD4 + T cells to evaluate antigen presentation by measuring interferon-γ(IFN-γ) and IL-17A secretion. Results:Plasma IL-37 level and IL-37 receptor subunit expression in monocytes were significantly lower in T1DM patients compared to controls(both P<0.001). However, there was no significant difference in soluble IL-1R8 levels between the groups( P=0.457). Monocytes from T1DM patients exhibited increased cytotoxicity, as indicated by higher target cell death and elevated levels of granzyme A, granzyme B, granzyme H, IL-1β, IL-6, and tumor necrosis factor-α( P<0.05). Additionally, monocyte-induced secretion of IFN-γ and IL-17A by CD4 + T cells was elevated in T1DM patients(all P<0.05). Stimulation of T1DM monocytes with recombinant IL-37 reduced target cell death and decreased granzyme B secretion compared to unstimulated monocytes(both P<0.05). However, IL-37 stimulation had no significant effect on other cytokine levels or monocyte-induced IFN-γ and IL-17A secretion( P>0.05). Conclusions:Monocytes exhibit enhanced cytotoxicity and antigen-presenting capacity in T1DM patients. IL-37 reduces monocyte cytotoxicity by inhibiting granzyme B secretion, but does not affect antigen presenting function in T1DM.

Objective:To explore and analyze the pre-hospital emergency situation of the general public in Xinxiang City through the knowledge, attitude and practice (KAP) model, and provide a basis for developing pre-hospital emergency training programs in the next step.Methods:Totally 544 residents from 4 streets of 4 districts in Xinxiang City, Henan Province were selected by random sampling and investigated with the pre-hospital emergency KAP questionnaire. Totally 544 questionnaires were distributed, and 536 of them were recovered.Results:The pre-hospital emergency knowledge, attitude and practice scores of the 536 respondents were (8.37±3.56) , (14.82±3.13) and (20.39±5.11) , respectively. There were statistically significant differences in pre-hospital emergency KAP scores between the respondents of different ages, education levels, and occupations ( P< 0.05) . Conclusions:The prevalence of pre-hospital emergency knowledge and the emergency ability in urban residents of Xinxiang City are generally low. Therefore, it is necessary to formulate appropriate training strategies for people of different ages, educational levels and occupations, and strengthen community emergency training.

Purpose: Recently, totally laparoscopic gastrectomy has been gradually accepted by surgeons worldwide for gastric cancer treatment. Complete dissection of the lymph nodes and the establishment of the surgical margin are the most important considerations for curative gastric cancer surgery. Previous studies have demonstrated that indocyanine green (ICG)-traced laparoscopic gastrectomy significantly improves the completeness of lymph node dissection. However, it remains difficult to identify the tumor location intraoperatively for gastric cancers that are staged ≤T3. Here, we investigated the feasibility of ICG fluorescence for lymph node mapping and tumor localization during totally laparoscopic distal gastrectomy. Materials and Methods: Preoperative and perioperative data from consecutive patients with gastric cancer who underwent a totally laparoscopic distal gastrectomy were collected and analyzed. The patients were categorized into the ICG (n=61) or the non-ICG (n=75) group based on whether preoperative endoscopic mucosal ICG injection was performed. Results: The ICG group had a shorter operation time and less intraoperative blood loss.Moreover, significantly more lymph nodes were harvested in the ICG group than the non-ICG group. No pathologically positive margin was found and there was no significant difference in either the proximal or distal surgical margins between the 2 groups. Conclusions Near-infrared fluorescence imaging with ICG can be successfully used in totally laparoscopic distal gastrectomy, and it contributes to both the completeness of D2 lymph node dissection and confirmation of the gastric transection line. Well-designed prospective randomized studies are needed in the future to fully validate our findings.

OBJECTIVE: To investigate the risk factors of postoperative pulmonary infection (PPI) in patients over 60 years of age with gastric cancer after radical gastrectomy. METHODS: Clinicopathological data of 373 patients over 60 years of age who underwent radical gastrectomy at Department IV of Gastrointestinal Cancer Center, Peking University Cancer Hospital, from April 2009 to December 2016 were retrospectively collected in this case-control study. The clinicopathological characteristics of patients with postoperative pulmonary infection (including postoperative atelectasis) and those without pulmonary infection were compared. A Student t-test (reported as Mean±SD if data matching normal distribution) or Mann-Whitney U test [reported as median (quartile) if data did not conform to normal distribution] was used to analyze continuous variables. A χ² test or Fisher exact tests (reported as number and percentage) was used for categorical variables. Multivariable logistic regression was used to analyze the risk factors for pulmonary infection after operation of gastric cancer.PPI was defined as postoperative patients with elevated body temperature (>38.0 degrees centigrade) for more than 24 hours; cough and expectoration; positive sputum bacteria culture;recent infiltration, consolidation or atelectasis confirmed by chest imaging examination. RESULTS: Among 373 patients, 50 cases had PPI(13.4%, PPI group), 323 cases had no PPI(86.6%, non-PPI group). There were 39 (78.0%) and 178(55.1%) patients with comorbidities (including hypertension, diabetes and cardiopulmonary disease) preoperatively in PPI and non-PPI group, respectively. The difference between two groups was statistically significant (χ²=9.325,P=0.002). The incidence of preoperative hypoalbuminemia in PPI group was also significantly higher than that in non-PPI group [10.0%(5/50) vs. 3.1% (10/323),χ²=4.098, P=0.048]. Compared to non-PPI group, the rate of total gastrectomy [54.0%(27/50) vs. 34.4% (111/323), χ²=12.501, P=0.002], postoperative wound pain [34.0%(17/50) vs. 11.8% (38/323),χ²=16.928, P<0.001], secondary operation [6.0%(3/50) vs. 0.6% (2/323), χ²=6.032, P=0.014] and the rate of gastric tube removal later than 7 days postoperatively [96.0%(48/50) vs. 84.5%(273/323),χ²=4.811, P=0.028] were significantly higher in PPI group, respectively. The postoperative hospital stay was also prolonged in PPI group [16.0(9.5) days vs. 12.0(5.0) days, U=4 275.0, P<0.001]. Multivariate logistic regression analysis showed that preoperative comorbidities (OR=4.008, 95%CI:1.768-9.086, P=0.001), abdominal infection (OR=3.164, 95%CI:1.075-9.313, P=0.037), and wound pain (OR=3.428, 95%CI:1.557-7.548, P=0.002) were independent risk factors for PPI in patients over 60 years of age with gastric cancer. Furthermore, 50 patients with pulmonary infection were classified according to the length of latency and the type of infection. The patients with PPI latency ≤ 3 days were classified as early onset (34 cases, 68.0%), and those with latency ≥ 4 days as delayed onset (16 cases, 32.0%); PPI combined with surgical infection (including anastomotic leakage, abdominal infection, duodenal stump leakage, wound infection, etc.) was classified into mixed infection group (13 cases, 26.0%), with non-surgical infection as simple infection group (37 cases, 74.0%). The results showed that the pulmonary infection occurred 0 to 12 days (median 3 days) before surgical infection in mix infection group. The incidence of previous chronic obstructive pulmonary disease (COPD) in patients with early onset was significantly higher than that in patients with delayed onset [17.6%(6/34) vs. 0, χ²=5.005, P=0.025], and the incidence of mixed infection in patients with delayed onset was significantly higher than that in patients with early onset [50%(8/16) vs. 14.7%(5/34), χ²=6.730, P=0.009],but there was no significant difference in postoperative hospital stay between the two groups[17.0(9.8) days vs. 14.0(9.5) days, U=224.0, P=0.317]. CONCLUSIONS Postoperative pulmonary infection is common in gastric cancer patients over 60 years of age. Preoperative comorbidities, abdominal infection and wound pain are independent risk factors for postoperative pulmonary infection. Pulmonary infection within 3 days after operation is associated with preoperative COPD. For patients suffering from PPI after the 4th day,attentions should be paid to abdominal infection and anastomotic leakage.
Age Factors ; Anastomotic Leak ; etiology ; Case-Control Studies ; Gastrectomy ; adverse effects ; methods ; Humans ; Intraabdominal Infections ; etiology ; Middle Aged ; Pneumonia ; etiology ; Pulmonary Atelectasis ; etiology ; Pulmonary Disease, Chronic Obstructive ; complications ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms ; complications ; surgery

Objective: To explore the effect of voluntary teaching for medical students on cardio-pulmonary resuscitation training for middle school students,and to provide a reference for education of first aid among primary and middle school students. Methods: A total of 196 students from four classes in the first grade of a middle school were selected by convenient sampling method and divided into experimental group and control group according to the class. After the two groups of students were trained in unified theory, the students in the control group were trained by the medical staff in the hospital, and the students in the experimental group were trained by the volunteers of the medical students who had been strictly trained and assessed. After the training was finished, questionnaires were sent out to investigate the effect of training. Results: Before the training, there was no significant difference in the theoretical scores between the two groups (t=1.18，P=0.24). After training, the theoretical and skill scores of the experimental group were(11.43±1.53)(5.68±1.80), that of the control group were(11.35±1.77)(5.30±1.76), and there was no significant difference between the experimental group and the control group(t=0.34，1.48，P>0.05). Conclusion The application of voluntary teaching in the training of middle school students’ cardiopulmonary resuscitation can improve the popularization rate of cardiopulmonary resuscitation, save medical resources effectively, and improve the practical ability of medical students.

OBJECTIVE: To evaluate the safety and feasibility of laparoscopy-assisted total gastrectomy in gastric cancer patients over 65 years old. METHODS: Clinical, pathological and follow-up data of 188 gastric cancer patients who underwent laparoscopy-assisted total gastrectomy at Department IV of Gastrointestinal Cancer Center, Peking University Cancer Hospital, from April 2009 to December 2016 were collected for a retrospective cohort study. INCLUSION CRITERIA: ECOG performance score 0-1; preoperative gastroscopy discovered gastric masses, and pathological biopsy confirmed adenocarcinoma; distant metastases were excluded by image examination; preoperative cardiopulmonary function was normal; preoperative blood routine test, liver and renal function, and coagulation function were normal; laparoscopy-assisted total gastrectomy was performed. EXCLUSION CRITERIA: intraoperative laparoscopic exploration indicated abdominal and/or pelvic peritoneal metastasis; free cancer cells in peritoneal cavity; conversion to laparotomy during laparoscopic surgery. Patients were divided by age into 2 groups, ≥ 65 years old group(59 cases) and < 65 years old group (129 cases). The perioperative conditions and postoperative complications between two groups were compared, and the high risk factors of postoperative complications in patients over 65 years old were analyzed. RESULTS: All the patients were operated by the same operation team. The incidence of comorbidities was 44.1%(26/59) in the ≥ 65 years old group, which was significantly higher than 20.2% (26/129) in the < 65 years old group (χ²=11.570, P=0.001). The incidence of cardia/fundus cancer was 64.4%(38/59) in the ≥ 65 years old group, which was also significantly higher than 40.3% (52/129) in the < 65 years old group (χ²=16.625, P=0.001). The number of retrieved lymph nodes in the ≥65 years old group was significantly lower than that in the < 65 years old group (28.9±10.7 vs. 36.1±15.4, t=3.271, P=0.001). The total morbidity of complications was 13.8%(21/188) and the mortality within 30 days after operation was 1.6%(3/188). The morbidity of postoperative complications and the mortality within 30 days after operation were 20.3%(12/59) and 3.4%(2/59,respectively) in the ≥ 65 years old group, which were slightly higher than those in the <65 years old group [10.9%(14/129) and 0.8%(1/129)], without significant difference(both P>0.05). Multivariate logistic regression analysis showed that preoperative comorbidities(OR=0.223, 95%CI:0.053 to 0.944, P=0.041) was an independent risk factor for postoperative complications in patients aged ≥ 65 years old undergoing laparoscopy-assisted total gastrectomy. The median survival time was 21.3 months and the overall 5-year survival rate was 50.0%. The 5-year survival rate was 45.5% and 57.5% in patients aged ≥ 65 and < 65 years, respectively, and there was no significant difference(P=0.205). CONCLUSIONS Laparoscopy-assisted total gastrectomy is safe and effective in the treatment of gastric cancer patients ≥ 65 years old. Age is not a contraindication of laparoscopy-assisted total gastrectomy.
Aged ; Cohort Studies ; Gastrectomy ; instrumentation ; Humans ; Laparoscopy ; Postoperative Complications ; Retrospective Studies ; Stomach Neoplasms ; surgery ; Treatment Outcome

Objective: This study aimed to compare the short- and long-term outcomes of laparoscopy-assisted radical gastrectomy between elderly and non-elderly patients with gastric cancer. Methods: A total of 219 patients who underwent laparoscopy-assisted radical gastrectomy in the Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute from April 2009 to October 2013 were included in this retrospective study. All patients were divided into elderly (≥65 years) and non- elderly (<65 years)groups. We compared these groups based on clinicopathological characteristics, postoperative morbidities, and survival. Results:Theelderly group showed higher ASA scores and higher number of preoperative comorbidities (P<0.05). The operative time, blood loss,and conversion rate did not differ significantly between the groups (all P>0.05). The mean time to first ambulation in elderly group was 2.2±2.3d while first ambulation time in the non-elderly group was 1.4±1.3d,which showed significant difference between the two groups (P<0.05). No significant differences were observed between groups in terms of postoperativemorbidities (34.8％ vs. 28.5％, P> 0.05) as well as 3-year disease-free survival and overall survival (P>0.05). However, the elderly patients withpostoperative morbidities experienced significantly poorer overall survival rate than non-elderly patients (44.5％ vs. 70.5％, P<0.05). Conclusion: Laparoscopy-assisted gastrectomy can be safely and successfully performed in an elderly population with acceptable short- and long-term outcomes.Enhanced perioperative treatment is necessary to improve postoperative outcomes.