Objective: To evaluate the efficacy of the left spermatic vein transposition to the great saphenous vein in treating left varicocele (VC) secondary to nutcracker syndrome (NCS). Methods: Clinical data of 8 patients treated during Feb.2020 and Feb.2023 in our hospital were retrospectively analyzed.A meticulous preoperative evaluation of the vascular status of the spermatic vein and the great saphenous vein was performed using color Doppler ultrasound.A spermatic vein-great saphenous vein shunt surgery was performed in patients who were strictly selected.The clinical symptoms and hemodynamics of renal vein were compared before and after operation. Results: The median age of patients was 23.5(18-33) years.There was a notable reduction in post-exercise scrotal and lower back pain in all patients，and the score of scrotal pain decreased to 0 in 7 patients. The median quantification of urinary protein was 352.8(54.4-687.3) mg prior to surgical intervention，which significantly diminished to 125.5(25.9-255.1) mg 6 months after operation.Notably，3 cases of preoperative positive urine occult blood tests were undetectable in the subsequent postoperative assessments.The median peak blood flow velocity at the site of stenosis in the left renal vein measured at 74.4(48.7-117.6) cm/s preoperatively，subsequently reduced to 45.1(25.5-61.2) cm/s postoperatively.During the 6-month follow-up，no recurrence of varicocele，vascular anastomotic stenosis or thrombosis were observed. Conclusion: Our research indicates that spermatic vein to great saphenous vein bypass is safe and feasible in the treatment of left varicocele secondary to nutcracker syndrome for strictly selected patients，which can effectively alleviate renal vein congestion without significant complications.

Objective To explore the preference of medical staff in public hospitals for various incentive factors,and to provide theoretical basis for the hospital to formulate a reasonable incentive system and stimulate the enthusiasm of medical staff.Methods Based on the discrete choice experiment,it was conducted from March 2023 to June 2023,through the method of multistage stratified random sampling,the medical staff of a general hospital,a Traditional Chinese Medical Hospital and a maternal and child health hospital in one city in the east,west,south,north and middle of Hainan Province were investigated by questionnaire,and analyzed their incentive preference and willingness to pay by using the mixed logit model.Results All the six attributes have significant influence on medical staff's incentive preference,among which,medical staff prefer to choose the incentive effect brought by the annual salary of 350 000 yuan,good working atmosphere and working intensity of 8 hours,while hospital development has little influence on incentive preference.Among the non-economic factors,when the working atmosphere changes from depression to good,they are willing to get an annual salary of 168 305.4 yuan less,while when the hospital development changes from nothing to good,they are only willing to get an annual salary of 12 433.14 yuan less.Conclusion According to the different incentive needs of medical staff,it is more helpful to formulate accurate incentive schemes and adopt economic and non-economic incentive means to stabilize the hospital talent team and improve work enthusiasm.

Objective To explore the preference of medical staff in public hospitals for various incentive factors,and to provide theoretical basis for the hospital to formulate a reasonable incentive system and stimulate the enthusiasm of medical staff.Methods Based on the discrete choice experiment,it was conducted from March 2023 to June 2023,through the method of multistage stratified random sampling,the medical staff of a general hospital,a Traditional Chinese Medical Hospital and a maternal and child health hospital in one city in the east,west,south,north and middle of Hainan Province were investigated by questionnaire,and analyzed their incentive preference and willingness to pay by using the mixed logit model.Results All the six attributes have significant influence on medical staff's incentive preference,among which,medical staff prefer to choose the incentive effect brought by the annual salary of 350 000 yuan,good working atmosphere and working intensity of 8 hours,while hospital development has little influence on incentive preference.Among the non-economic factors,when the working atmosphere changes from depression to good,they are willing to get an annual salary of 168 305.4 yuan less,while when the hospital development changes from nothing to good,they are only willing to get an annual salary of 12 433.14 yuan less.Conclusion According to the different incentive needs of medical staff,it is more helpful to formulate accurate incentive schemes and adopt economic and non-economic incentive means to stabilize the hospital talent team and improve work enthusiasm.

Objective: To elucidate the differences in manual acupuncture effectiveness at sensitized points by investigating the mechanisms of local skin action at different sensitization points in rats with knee osteoarthritis (KOA). Methods: Forty Sprague–Dawley rats were equally divided into control, model (1 mg of monoiodoacetate into the right knee joint cavity), sham operation, manual acupuncture at right Tianjing acupoint (MAR-SJ 10), and left SJ 10 groups. Safranine-O and fast green staining were used to assess the modeling. The morphological and functional changes in mast cells (MCs) were assessed during acupoint sensitization using toluidine blue and immunofluorescence staining. The levels of serotonin, histamine, substance P (SP), and tryptase at skin acupoints and serum levels of IL-β, IL-6, and TNF-α were detected using ELISA. Results: After 14 days of treatment, the number of MCs and their degranulation rates were statistically higher in the model group than in the control group (both P < .001). After applying acupuncture, the levels of 5-HT, HA, and SP at skin acupoints were lower than those in the model group (all P < .05), and tryptase level was higher (both P < .05). Tryptase level was higher on the skin at the MAL-SJ 10 acupoint than that on the MAR-SJ 10 acupoint (P = .004). Compared with the model group, the serum levels of IL-1β, IL-6, and TNF-α in the MAR-SJ 10 and MAL-SJ 10 groups were lower (all P < .05). Conclusion Acupuncture at KOA-sensitized acupoints mitigates joint injury in KOA rats and may bidirectionally regulate local MCs of these acupoints. This finding not only enhances the reference value of sensitizing points in clinical diagnosis and treatment, but also contributes to the understanding of the biological mechanisms underlying acupuncture intervention at sensitizing points.

Objective To explore the preference of medical staff in public hospitals for various incentive factors,and to provide theoretical basis for the hospital to formulate a reasonable incentive system and stimulate the enthusiasm of medical staff.Methods Based on the discrete choice experiment,it was conducted from March 2023 to June 2023,through the method of multistage stratified random sampling,the medical staff of a general hospital,a Traditional Chinese Medical Hospital and a maternal and child health hospital in one city in the east,west,south,north and middle of Hainan Province were investigated by questionnaire,and analyzed their incentive preference and willingness to pay by using the mixed logit model.Results All the six attributes have significant influence on medical staff's incentive preference,among which,medical staff prefer to choose the incentive effect brought by the annual salary of 350 000 yuan,good working atmosphere and working intensity of 8 hours,while hospital development has little influence on incentive preference.Among the non-economic factors,when the working atmosphere changes from depression to good,they are willing to get an annual salary of 168 305.4 yuan less,while when the hospital development changes from nothing to good,they are only willing to get an annual salary of 12 433.14 yuan less.Conclusion According to the different incentive needs of medical staff,it is more helpful to formulate accurate incentive schemes and adopt economic and non-economic incentive means to stabilize the hospital talent team and improve work enthusiasm.

Objective To explore the preference of medical staff in public hospitals for various incentive factors,and to provide theoretical basis for the hospital to formulate a reasonable incentive system and stimulate the enthusiasm of medical staff.Methods Based on the discrete choice experiment,it was conducted from March 2023 to June 2023,through the method of multistage stratified random sampling,the medical staff of a general hospital,a Traditional Chinese Medical Hospital and a maternal and child health hospital in one city in the east,west,south,north and middle of Hainan Province were investigated by questionnaire,and analyzed their incentive preference and willingness to pay by using the mixed logit model.Results All the six attributes have significant influence on medical staff's incentive preference,among which,medical staff prefer to choose the incentive effect brought by the annual salary of 350 000 yuan,good working atmosphere and working intensity of 8 hours,while hospital development has little influence on incentive preference.Among the non-economic factors,when the working atmosphere changes from depression to good,they are willing to get an annual salary of 168 305.4 yuan less,while when the hospital development changes from nothing to good,they are only willing to get an annual salary of 12 433.14 yuan less.Conclusion According to the different incentive needs of medical staff,it is more helpful to formulate accurate incentive schemes and adopt economic and non-economic incentive means to stabilize the hospital talent team and improve work enthusiasm.

Objective To explore the preference of medical staff in public hospitals for various incentive factors,and to provide theoretical basis for the hospital to formulate a reasonable incentive system and stimulate the enthusiasm of medical staff.Methods Based on the discrete choice experiment,it was conducted from March 2023 to June 2023,through the method of multistage stratified random sampling,the medical staff of a general hospital,a Traditional Chinese Medical Hospital and a maternal and child health hospital in one city in the east,west,south,north and middle of Hainan Province were investigated by questionnaire,and analyzed their incentive preference and willingness to pay by using the mixed logit model.Results All the six attributes have significant influence on medical staff's incentive preference,among which,medical staff prefer to choose the incentive effect brought by the annual salary of 350 000 yuan,good working atmosphere and working intensity of 8 hours,while hospital development has little influence on incentive preference.Among the non-economic factors,when the working atmosphere changes from depression to good,they are willing to get an annual salary of 168 305.4 yuan less,while when the hospital development changes from nothing to good,they are only willing to get an annual salary of 12 433.14 yuan less.Conclusion According to the different incentive needs of medical staff,it is more helpful to formulate accurate incentive schemes and adopt economic and non-economic incentive means to stabilize the hospital talent team and improve work enthusiasm.

Objective To explore the preference of medical staff in public hospitals for various incentive factors,and to provide theoretical basis for the hospital to formulate a reasonable incentive system and stimulate the enthusiasm of medical staff.Methods Based on the discrete choice experiment,it was conducted from March 2023 to June 2023,through the method of multistage stratified random sampling,the medical staff of a general hospital,a Traditional Chinese Medical Hospital and a maternal and child health hospital in one city in the east,west,south,north and middle of Hainan Province were investigated by questionnaire,and analyzed their incentive preference and willingness to pay by using the mixed logit model.Results All the six attributes have significant influence on medical staff's incentive preference,among which,medical staff prefer to choose the incentive effect brought by the annual salary of 350 000 yuan,good working atmosphere and working intensity of 8 hours,while hospital development has little influence on incentive preference.Among the non-economic factors,when the working atmosphere changes from depression to good,they are willing to get an annual salary of 168 305.4 yuan less,while when the hospital development changes from nothing to good,they are only willing to get an annual salary of 12 433.14 yuan less.Conclusion According to the different incentive needs of medical staff,it is more helpful to formulate accurate incentive schemes and adopt economic and non-economic incentive means to stabilize the hospital talent team and improve work enthusiasm.

Objective To construct and validate of a nomogram predictive model for high-volume lymph node metastasis(HVM)in multifocal papillary thyroid carcinoma(MPTC).Methods Between January 2010 to January 2024,a total of 1146 and 234 patients with multifocal papillary thyroid carcinoma(MPTC)were diagnosed at Hangzhou First People's Hospital(Center A)and Hangzhou Cancer Hospital(Center B),respectively.Patients from Center A were randomly allocated to training set(n=803)and testing set(n=343)in a 7:3 ratio,while those from Center B(n=234)comprised an external validation set.Independent risk factors for HVM in MPTC patients were identified through univariate and multivariate Logistic regression analysis in training set,leading to the development of a nomogram predictive model.The generalizability of this model was subsequently assessed using both testing set and external validation set.The area under the curve(AUC)of receiver operating characteristic curve,sensitivity,and specificity evaluate the discriminative ability of the model.Results The incidence of HVM was 13.3％at center A and 12.8％at center B.Logistic regression identified male gender(OR=2.91,95％CI:1.835-4.599),maximum lesion diameter(OR=1.05,95％CI:1.021-1.070),and age(OR=0.95,95％CI:0.936-0.972)as independent risk factors for HVM.Anomogram based on these factors showed an AUC of 0.767 with 72.6％sensitivity and 70.2％specificity in training set,and 0.838 with 94.9％sensitivity and 68.4％specificity in testing set,and 0.769 with 63.3％sensitivity and 84.3％specificity in external validation set.The calibration curve demonstrated good agreement with the ideal curve.Conclusion The prediction model constructed based on clinical risk factors can effectively predict the probability of HVM in MPTC patients.

Objective To investigate the effect of diammonium glycyrrhizinate(DG)on pulmonary injury of rats with pulmonary tuberculosis.Methods The rat models of pulmonary tuberculosis were constructed and then the an-imals were randomly divided into model group,diammonium glycyrrhizinate treatment groups(low-dose,medium-dose and high-dose)groups,high dose of diammonium glycyrrhizinate plus peroxisome proliferator-activated receptor γ(PPARγ)inhibitor group(H-DG+GW9662 group),and another 18 rats were selected as control group.The colony count of Mycobacterium tuberculosis(Mtb)in lung tissue was detected.HE staining microscopy was ap-plied to detect lung histopathology.TUNEL was applied to detect apoptosis of lung tissue cells.ELISA was applied to detect serum level of inflammatory factors.Western blot was applied to measure PPARγ,phosphorylated p38 mi-togen-activated protein kinase(p-p38MAPK)and p38 mitogen-activated protein kinase(p38MAPK)in lung tissue.Results Compared with the control group,the lung tissue structure in model group was severely damaged with a large number of proliferative tuberculosis nodules,changes of alveolar morphology,inflammatory cell infiltration and even caseous necrosis were found,and the number of tuberculosis colonies,apoptosis rate,TNF-α,IL-6,IFN-γ,COX-2 levels,and p-p38MAPK/p38MAPK expression were all increased,while PPARγ expression was decreased(P＜0.05).In L-DG,M-DG,H-DG groups improvement of lung tissue structure,alveolar morphology,inflammatory cell infiltration,and caseous necrosis were found as compared to the model group,while the counting number of tuberculosis colonies decreased and rate of cell apoptosis decreased.The level of TNF-α,IL-6,IFN-γ,COX-2 and expression of p-p38MAPK/p38MAPK reduced,the expression of PPARγ all increased.The H-DG group showed the most significant changes(P＜0.05).GW9662 treatment significantly reversed the improvement of DG on pulmonary injury in rats with pulmonary tuberculosis.Conclusions DG improves lung injury in rats with pul-monary tuberculosis and its mechanism is potentially related to the activation of PPARγ pathway and inhibition of p38MAPK pathway.