Vascular endothelial growth factor (VEGF) inhibitors are drugs that target and inhibit tumor angiogenesis. By blocking the signaling pathway of VEGF and its receptor, they suppress tumor proliferation and play a crucial role in tumor treatment. However, their side effects, such as hypertension, proteinuria, hand-foot skin reactions, and myelosuppression, during treatment seriously affect patients' treatment compliance and quality of life. The development of intervention strategies for the side effects of VEGF inhibitors is of great importance for tumor treatment. This article reviews the clinical characteristics and toxic mechanisms of common side effects caused by VEGF inhibitors during tumor treatment and summarizes intervention strategies that combine traditional Chinese and Western medicines. Drug dosages were precisely monitored and adjusted to achieve antitumor treatment. Patients' discomfort symptoms are improved through prescriptions that act by tonifying qi and promoting blood circulation, strengthening the spleen, and tonifying the kidney. The combination of traditional Chinese and Western medicines is used to treat patients, thus providing a safe and effective treatment plan for patients with cancer.

Glucagon and insulin are the main regulatory factors for blood glucose and jointly maintain the homeostasis of energy me-tabolism in the body,but the internal mechanism of the mutual regulation and influence between them remains complex and unclear.The liver is one of the key target organs for both insulin and glucagon,playing a crucial role in maintaining the homeostasis of glucose and lipid metabolism.Insulin resistance is often accompanied by abnormal glucose and lipid metabolism in the liver,which may affect the functional activity of glucagon in the liver.There is a glucagon-related feedback loop between the liver and the pancreas,known as the"liver-α-cell axis",which may play a critical role in understanding the metabolic effect of glucagon in the state of insulin resis-tance.In addition to the regulation of glucose homeostasis,the physiological action of glucagon has been extended to lipid and amino acid metabolism.Therefore,abnormal regulation of glucagon metabolism may further lead to the imbalance of glucose,lipid,and amino acid metabolism.This article briefly reviews the regulatory mechanism of glucagon in liver glucose homeostasis,lipid metabolism,and amino acid metabolism in physiological condition and the state of insulin resistance.

Objective:To investigate the risk factors for new adjacent vertebral fracture after percutaneous kyphoplasty (PKP) in patients with osteoporotic vertebral compression fracture (OVCF) and their predictive efficacy.Methods:A retrospective cohort study was conducted to analyze the clinical data of 476 OVCF patients admitted to The Affiliated Wuxi People′s Hospital of Nanjing Medical University from January 2018 to December 2024, including 74 males and 402 females, aged 49-91 years [71(65, 79)years]. Among them, 397 patients underwent single-level PKP, while 79 received multi-level PKP. Surgical segments involved T 6 in 9 patients, T 7 in 9, T 8 in 14, T 9 in 12, T 10 in 9, T 11 in 50, T 12 in 110, L 1 in 173, L 2 in 77, L 3 in 46, L 4 in 31, and L 5 in 13. The patients were divided into adjacent vertebral fracture group ( n=55) and non-adjacent vertebral fracture group ( n=421) according to whether adjacent vertebral fracture was observed during the follow-up. The following data were collected in both groups: gender, age, body mass index (BMI), bone mineral density T-value, underlying diseases (hypertension, diabetes, coronary heart disease), prior cerebral infarction, history of OVCF, long-term glucocorticoid use, thoracolumbar fracture, number of operated vertebrae, cement injection approach (unilateral or bilateral), mean cement dose, postoperative vertebral height restoration rate, postoperative Cobb angle correction, postoperative thoracolumbar kyphosis angle correction, and cement distribution score. Univariate and multivariate Logistic stepwise regression analysis were performed to assess and identify independent risk factors for adjacent vertebral fracture in OVCF patients after PKP. Receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to evaluate the risk factors′ predictive performance for adjacent vertebral fracture in OVCF patients after PKP. Results:Univariate analysis revealed significant differences in age, bone mineral density T-value, history of OVCF, long-term glucocorticoid use, number of operated vertebrae, and cement distribution score between the two groups ( P<0.05). The multivariate Logistic stepwise regression analysis showed that the bone mineral density T-value ( OR=0.68, 95% CI 0.48, 0.95, P<0.05) and cement distribution score ( OR=0.61, 95% CI 0.49, 0.76, P<0.01) were significantly correlated with new adjacent vertebral fractures after PKP. The ROC curve analysis showed that bone cement distribution score showed better predictive performance (AUC=0.72, 95% CI 0.64, 0.79), compared with bone mineral density T-value (AUC=0.62, 95% CI 0.54, 0.70), while the combined predictive performance of the two factors was the best (AUC=0.75, 95% CI 0.68, 0.81). Conclusions:Bone mineral density T-value and cement distribution score are independent risk factors for new adjacent vertebral fracture in OVCF patients after PKP. The predictive performance of cement distribution score is proved to be good and can be better in combination with bone mineral density T-value.

Objective:To investigate the current situation of adverse events in hemodialysis nursing in class-A tertiary hospitals in China and analyze their nursing human resources related influencing factors, aiming at provide references for hemodialysis centers to adjust nursing human resources scientifically to reduce the occurrence of nursing adverse events.Methods:A convenient sampling method was used. From August to October 2021, a self-designed questionnaire was used to investigate nursing adverse events in hemodialysis centers of 860 class-A tertiary hospitals during 2020 in China. Multivariate Logistic regression was used to analyze the influencing factors of blood loss, hemodialysis catheter-related blood stream infection (CRBSI) and venous needle dislodgement (VND) in hemodialysis centers.Results:A total of 826 valid questionnaires were received, with an effective response rate of 96.05%(826/860). There were 826 hemodialysis centers covering 31 provinces, municipalities and autonomous regions in China. The establishment period of each center was 24(18, 30) years. There were 45(30, 62) dialysis machines, 180(110, 260) patients and 19(13, 27) registered nurses. Blood loss, hemodialysis CRBSI and VND occurred in 70.94% (586/826), 68.04%(562/826) and 46.97% (388/826) of hemodialysis centers, respectively. Multivariate Logistic regression results showed that the daily treatment shift ( OR=0.730, 95% CI 0.536-0.994), the proportion of nurses with bachelor's degree or above ( OR=1.635, 95% CI 1.142-2.342), and whether nurses worked part-time on peritoneal dialysis treatment ( OR=0.225, 95% CI 0.052-0.965) were the influencing factors for blood loss in hemodialysis centers (all P<0.05). The daily treatment shift ( OR=0.566, 95% CI 0.413-0.777), the number of patients which each nurse was responsible for per shift simultaneously ( OR=0.549, 95% CI 0.400-0.753), proportion of blood purification specialized nurses ( OR=1.661, 95% CI 1.216-2.269), whether nurses worked part-time on CRRT ( OR=0.700, 95% CI 0.511-0.957), the education level of the nursing manager was junior college and below ( OR=3.789, 95% CI 1.576-9.113) and bachelor′s degree ( OR=2.585, 95% CI 1.328-5.033) were the influencing factors for the hemodialysis catheter-associated bloodstream infection in hemodialysis centers (all P<0.05). The number of patients which each nurse ( OR=0.580, 95% CI 0.433-0.777) was responsible for per shift simultaneously was the influencing factor in the occurrence of VND in hemodialysis centers ( P<0.05). Conclusions:The nursing adverse events of blood loss, hemodialysis catheter-associated bloodstream infection and VND were relatively common in hemodialysis centers. The hospital managers should take corresponding measures aiming at the above influencing factors to prevent the occurrence of nursing adverse events and improve the quality and safety of nursing.

Objective To observe the value of 68Ga-DOTA-NOC PET/CT for diagnosing pheochromocytoma(PCC)and paraganglioma(PGL).Methods Thirty-eight patients with suspected or confirmed PCC/PGL who underwent 68 Ga-DOTA-NOC PET/CT were retrospectively enrolled,among them 20 cases underwent 131I-metaiodobenzylguanidine(MIBG)SPECT/CT during the same period.The value of 68Ga-DOTA-NOC PET/CT for diagnosing PCC/PGL at individual and lesion levels were analyzed and compared to the results of 131I-MIBG SPECT/CT.Results Among 38 cases,there were 20 cases of PCC,14 cases of PGL,1 case of adrenocortical carcinoma and 3 cases of benign adrenal hyperplasia.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of 68 Ga-DOTA-NOC PET/CT for diagnosing PCC/PGL in all 38 cases was 87.88％(29/33),60.00％(3/5),93.55％(29/31),42.86％(3/7)and 84.21％(32/38),respectively.Totally 188 lesions were detected in 34 cases,with detection rate of 89.95％(188/209).For 20 patients who underwent both 2 kinds examinations,the detection rate of bone,lymph node,liver,lung metastases and the overall lesions of 68Ga-DOTA-NOC PET/CT were all higher than those of 131I-MIBG SPECT/CT(all P＜0.05).No significant difference of diagnostic accuracy of PCC/PGL was found between 68 Ga-DOTA-NOC PET/CT and 131I-MIBG SPECT/CT(P＞0.05).Conclusion The value of 68 Ga-DOTA-NOC PET/CT for diagnosing PCC/PGL was comparable to that of 131I-MIBG SPECT/CT,but the former showed higher detection rate of metastases,hence being helpful to staging and risk stratification of PCC/PGL.

Objective To observe the value of 68Ga-DOTA-NOC PET/CT for diagnosing pheochromocytoma(PCC)and paraganglioma(PGL).Methods Thirty-eight patients with suspected or confirmed PCC/PGL who underwent 68 Ga-DOTA-NOC PET/CT were retrospectively enrolled,among them 20 cases underwent 131I-metaiodobenzylguanidine(MIBG)SPECT/CT during the same period.The value of 68Ga-DOTA-NOC PET/CT for diagnosing PCC/PGL at individual and lesion levels were analyzed and compared to the results of 131I-MIBG SPECT/CT.Results Among 38 cases,there were 20 cases of PCC,14 cases of PGL,1 case of adrenocortical carcinoma and 3 cases of benign adrenal hyperplasia.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of 68 Ga-DOTA-NOC PET/CT for diagnosing PCC/PGL in all 38 cases was 87.88％(29/33),60.00％(3/5),93.55％(29/31),42.86％(3/7)and 84.21％(32/38),respectively.Totally 188 lesions were detected in 34 cases,with detection rate of 89.95％(188/209).For 20 patients who underwent both 2 kinds examinations,the detection rate of bone,lymph node,liver,lung metastases and the overall lesions of 68Ga-DOTA-NOC PET/CT were all higher than those of 131I-MIBG SPECT/CT(all P＜0.05).No significant difference of diagnostic accuracy of PCC/PGL was found between 68 Ga-DOTA-NOC PET/CT and 131I-MIBG SPECT/CT(P＞0.05).Conclusion The value of 68 Ga-DOTA-NOC PET/CT for diagnosing PCC/PGL was comparable to that of 131I-MIBG SPECT/CT,but the former showed higher detection rate of metastases,hence being helpful to staging and risk stratification of PCC/PGL.

Objective:To investigate the current situation of adverse events in hemodialysis nursing in class-A tertiary hospitals in China and analyze their nursing human resources related influencing factors, aiming at provide references for hemodialysis centers to adjust nursing human resources scientifically to reduce the occurrence of nursing adverse events.Methods:A convenient sampling method was used. From August to October 2021, a self-designed questionnaire was used to investigate nursing adverse events in hemodialysis centers of 860 class-A tertiary hospitals during 2020 in China. Multivariate Logistic regression was used to analyze the influencing factors of blood loss, hemodialysis catheter-related blood stream infection (CRBSI) and venous needle dislodgement (VND) in hemodialysis centers.Results:A total of 826 valid questionnaires were received, with an effective response rate of 96.05%(826/860). There were 826 hemodialysis centers covering 31 provinces, municipalities and autonomous regions in China. The establishment period of each center was 24(18, 30) years. There were 45(30, 62) dialysis machines, 180(110, 260) patients and 19(13, 27) registered nurses. Blood loss, hemodialysis CRBSI and VND occurred in 70.94% (586/826), 68.04%(562/826) and 46.97% (388/826) of hemodialysis centers, respectively. Multivariate Logistic regression results showed that the daily treatment shift ( OR=0.730, 95% CI 0.536-0.994), the proportion of nurses with bachelor's degree or above ( OR=1.635, 95% CI 1.142-2.342), and whether nurses worked part-time on peritoneal dialysis treatment ( OR=0.225, 95% CI 0.052-0.965) were the influencing factors for blood loss in hemodialysis centers (all P<0.05). The daily treatment shift ( OR=0.566, 95% CI 0.413-0.777), the number of patients which each nurse was responsible for per shift simultaneously ( OR=0.549, 95% CI 0.400-0.753), proportion of blood purification specialized nurses ( OR=1.661, 95% CI 1.216-2.269), whether nurses worked part-time on CRRT ( OR=0.700, 95% CI 0.511-0.957), the education level of the nursing manager was junior college and below ( OR=3.789, 95% CI 1.576-9.113) and bachelor′s degree ( OR=2.585, 95% CI 1.328-5.033) were the influencing factors for the hemodialysis catheter-associated bloodstream infection in hemodialysis centers (all P<0.05). The number of patients which each nurse ( OR=0.580, 95% CI 0.433-0.777) was responsible for per shift simultaneously was the influencing factor in the occurrence of VND in hemodialysis centers ( P<0.05). Conclusions:The nursing adverse events of blood loss, hemodialysis catheter-associated bloodstream infection and VND were relatively common in hemodialysis centers. The hospital managers should take corresponding measures aiming at the above influencing factors to prevent the occurrence of nursing adverse events and improve the quality and safety of nursing.

Objective:To investigate the risk factors for new adjacent vertebral fracture after percutaneous kyphoplasty (PKP) in patients with osteoporotic vertebral compression fracture (OVCF) and their predictive efficacy.Methods:A retrospective cohort study was conducted to analyze the clinical data of 476 OVCF patients admitted to The Affiliated Wuxi People′s Hospital of Nanjing Medical University from January 2018 to December 2024, including 74 males and 402 females, aged 49-91 years [71(65, 79)years]. Among them, 397 patients underwent single-level PKP, while 79 received multi-level PKP. Surgical segments involved T 6 in 9 patients, T 7 in 9, T 8 in 14, T 9 in 12, T 10 in 9, T 11 in 50, T 12 in 110, L 1 in 173, L 2 in 77, L 3 in 46, L 4 in 31, and L 5 in 13. The patients were divided into adjacent vertebral fracture group ( n=55) and non-adjacent vertebral fracture group ( n=421) according to whether adjacent vertebral fracture was observed during the follow-up. The following data were collected in both groups: gender, age, body mass index (BMI), bone mineral density T-value, underlying diseases (hypertension, diabetes, coronary heart disease), prior cerebral infarction, history of OVCF, long-term glucocorticoid use, thoracolumbar fracture, number of operated vertebrae, cement injection approach (unilateral or bilateral), mean cement dose, postoperative vertebral height restoration rate, postoperative Cobb angle correction, postoperative thoracolumbar kyphosis angle correction, and cement distribution score. Univariate and multivariate Logistic stepwise regression analysis were performed to assess and identify independent risk factors for adjacent vertebral fracture in OVCF patients after PKP. Receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to evaluate the risk factors′ predictive performance for adjacent vertebral fracture in OVCF patients after PKP. Results:Univariate analysis revealed significant differences in age, bone mineral density T-value, history of OVCF, long-term glucocorticoid use, number of operated vertebrae, and cement distribution score between the two groups ( P<0.05). The multivariate Logistic stepwise regression analysis showed that the bone mineral density T-value ( OR=0.68, 95% CI 0.48, 0.95, P<0.05) and cement distribution score ( OR=0.61, 95% CI 0.49, 0.76, P<0.01) were significantly correlated with new adjacent vertebral fractures after PKP. The ROC curve analysis showed that bone cement distribution score showed better predictive performance (AUC=0.72, 95% CI 0.64, 0.79), compared with bone mineral density T-value (AUC=0.62, 95% CI 0.54, 0.70), while the combined predictive performance of the two factors was the best (AUC=0.75, 95% CI 0.68, 0.81). Conclusions:Bone mineral density T-value and cement distribution score are independent risk factors for new adjacent vertebral fracture in OVCF patients after PKP. The predictive performance of cement distribution score is proved to be good and can be better in combination with bone mineral density T-value.

Objective To investigate the effect of esketamine on postoperative anxiety and cognitive function in gynecological malignant tumor patients with preoperative anxiety and cognitive decline.Methods Eighty-nine patients were selected for resection of gynecological malignant tumors,aged 18-64 years,BMI 18-28 kg/m2,ASA physical status Ⅱ or Ⅲ,the hospital anxiety and depression scale(HADS)anxiety subscale score≥8 points and montreal cognitive rating scale(MoCA)＜26 points 1 day before surgery.The patients were divided into two groups using the random number table method:the esket-amine group(group S,n = 45)and the normal saline group(group C,n = 44).In group S,esketamine 0.2 mg/kg was injected intravenously during anesthesia induction,0.25 mg·kg-1·h-1 was injected by pump during anesthesia maintenance,and esketamine 100 mg was used in the postoperative analgesic pump.Group C was given the same volume of normal saline during anesthesia induction,maintenance and PCIA analgesia,and other medications were the same as those in group S.HADS and MoCA were used to evaluate patients'anxiety and cognitive function 1 day before surgery and the 1 day and 3 days after surgery.The con-centration of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),S100 calcium-binding protein(S100β),and brain-derived neurotrophic factor(BDNF)were detected 1 day before surgery and 3 days af-ter surgery.The intraoperative dosage of remifentanil,ephedrine use rate,Ramsay sedation score 10 minutes after admission to PACU,extubation time,the number of total and effective compressions of PCIA within 48 hours after surgery,postoperative remedial analgesia,and the occurrence of adverse reactions,such as hy-pertension,hypotension,nausea and vomiting,chill,dizziness,and fever within 48 hours after surgerywere recorded.Results Compared with group C,the incidence of anxiety were significantly reduced and MoCA cognitive score were increased 1 day and 3 days after surgery,the concentrations of TNF-α,IL-6,and S100β were significantly reduced,the concentration of BDNF was significantly increased,the dosage of remifentanil was significantly reduced,the sedation score of Ramsay was significantly increased,the number of total compressions and effective compressions of PCIA within 48 hours after surgery was significantly re-duced,and postoperative fever was significantly reduced in group S(P＜0.05).There were no statistically significant differences in ephedrine use rate,extubation time,postoperative remedial analgesia rate,the in-cidence of other adverse reactions,such as hypertension,hypotension,nausea and vomiting,chills and diz-ziness within 48 hours after surgery between the two groups.Conclusion Esketamine can decrease the con-centrations of inflammatory factors and reduce nerve damage,help relieve anxiety and cognitive function of patients with gynecological malignant tumors.

Objective:To explore the application value of a novel separated magnetic-controlled forceps in transumbilical single-incision laparoscopic cholecystectomy (SILC).Methods:This is a prospective case series study. Data from patients who underwent SILC at the Department of General Surgery, the Second Affiliated Hospital of Air Force Medical University from March to August 2023 were prospectively collected, based on inclusion and exclusion criteria. All patients underwent cholecystectomy assisted by a novel separated magnetic-controlled forceps. Surgical time, intraoperative blood loss, the need for additional incisions during surgery, and the length of hospital stay were recorded to assess surgical difficulty and effectiveness. Postoperative pain scores and complications were documented to evaluate the safety of the procedure. The collaboration experience of the surgeon and assistant was evaluated using a 5-point Likert scale to assess the feasibility of this surgical approach. Informed consent was obtained from all patients in accordance with medical ethical regulations. Patients were followed up through outpatient visits or telephone calls, with follow-up at 7 days and 1 month after surgery, and evaluation of incisional scar healing and completion of satisfaction questionnaires. Follow-up was conducted until September 30, 2023.Results:A total of 45 patients were included in the study,including 19 males and 26 females,aged (42.7±4.2)years(range:32 to 61 years). The difficulty of the operation was evaluated as grade 1 or 2 in 38 cases(84.4%) and grade 3 in 7 cases(15.6%). Operation time was (37.3±5.3) minutes(range: 25 to 80 minutes),and intraoperative blood loss( M(IQR)) was 17.8(35.0) ml (range:10 to 60 ml). All surgical procedures proceeded smoothly without intraoperative incidents, and the overall satisfaction of the surgeon and assistants was high. All patients underwent successful day surgery management and were discharged within 48 hours of hospitalization. The postoperative pain scores at 1, 7, and 30 days were 3 (4), 1 (3), and 0 (2), respectively. The follow-up time was 5.0(2.2) weeks (range: 3 to 7 weeks), with no occurrence of grade 3 to 4 adverse reactions, and the patients were satisfied with the cosmetic effect of the umbilical incision. Conclusions:The novel separated magnetic-controlled forceps can be applied in transumbilical SILC. It has the advantages of convenient operation, and patients are satisfied with the surgical results.