Objective To explore the perioperative safety and prognostic factors of sequential hepatectomy after conversion therapy using vascular interventional therapy(including transarterial chemoembolization and hepatic arterial infusion chemotherapy)combined with tyrosine kinase inhibitors(TKI)and programmed death-1(PD-1)inhibitors in patients with initially unresectable hepatocellular carcinoma.Methods The clinical data of 106 eligible HCC patients treated in Tumor Hospital Affiliated to Guangxi Medical University from Nov.2019 to Apr.2024 were retrospectively analyzed.The perioperative parameters and postoperative pathological outcomes were described in detail,and factors influencing prognosis were analyzed.Results The median operative time for hepatectomy after conversion therapy was 240 min,with a median blood loss of 200 mL.Intraoperative blood transfusion was required in 24(22.6％)patients.Postoperative adverse reactions occurred in 49.1％(52/106)of patients,with liver failure being the most common adverse reactions(23 patients,21.7％).One(0.9％)patient died during the perioperative period,while the remaining 105 patients were followed up for a median duration of 14.7 months,during which 49(46.2％)patients experienced recurrence.Among them,39(36.8％)cases experienced early recurrence(within 1 year),and 33(31.1％)cases had intrahepatic recurrence.Thirteen(12.3％)patients died during follow-up.The median recurrence-free survival(RFS)was 15.7 months,with 1-year and 2-year RFS rates being 56.9％and 40.3％,respectively.The median overall survival(OS)was not reached,with 1-year and 2-year OS rates being 94.2％and 85.3％,respectively.Multivariate Cox regression analysis demonstrated that achieving complete pathological response(hazard ratio[HR]=0.410,95％confidence interval[CI]0.172-0.980,P=0.045),presence of microvascular invasion(HR=2.423,95％CI 1.269-4.625,P=0.007),satellite nodules(HR=1.916,95％CI 1.014-3.620,P=0.045),and multiple tumors(HR=1.818,95％CI 1.012-3.241,P=0.046)were independent factors associated with postoperative recurrence.Conclusion For patients with initially unresectable hepatocellular carcinoma,vascular interventional therapy combined with TKI and PD-1 inhibitors followed by sequential hepatectomy may be a feasible treatment strategy,with manageable adverse reactions and promising efficacy.

Objective:To establish UPLC characteristic spectrum of Hujiao standard decoction and the determination method for the content of piperine.Methods:15 batches of freeze-dried powder of Hujiao standard decoction were prepared according to the traditional decocting method. The range of paste yield was determined, and the UPLC characteristic spectrum of the standard decoction was established. High-resolution mass spectrometry and control products were used to identify common peaks. Based on the common peak area, the weights of each peak were compared using entropy weight method, and correlation analysis and similarity evaluation were conducted using clustering analysis and grey correlation method; a method for determining the content of piperine in Hujiao decoction pieces and freeze-dried powder of standard decoction was simultaneously established, and the transfer rate was calculated.Results:The extraction rate of 15 batches of freeze-dried powder of Hujiao standard decoction ranged from 10.4% to 16.8%, with an average of 14.0%. The content of piperine ranged from 12.2 to 30.0 mg/g, with an average of 18.5 mg/g, and the transfer rate ranged from 4.0% to 7.8%, with an average of 5.8%. Six common peaks were identified in the established characteristic spectrum and identified by high-resolution mass spectrometry and control products respectively. Peak 1 was N-trans-feruloyltyramine, peak 3 was piperine and the similarity was 0.959-1.000. Clustering analysis and grey correlation analysis showed that there was little difference between quality of Piperis Fructus and origins.Conclusion:In this study, the characteristic spectrum and content determination method of freeze-dried powder of Hujiao standard decoction are established, which can provide references for quality detection and control of Hujiao standard decoction or its derivative products.

ObjectiveTo explore the mental health status and its influencing factors among middle school students in Xide County， Liangshan Yi Autonomous Prefecture， and to provide references for mental health interventions for local middle school students. MethodsUsing a cross-sectional study design， one junior middle school and one senior middle school in Xide County， Liangshan Prefecture， Sichuan Province， were randomly selected on September 16， 2021， and two classes per grade in each school involving 288 students were recruited. Subjects were assessed using Patients' Health Questionnaire Depression Scale-9 item （PHQ-9）， Generalized Anxiety Disorder Scale-7 item （GAD-7）， PTSD Checklist for DSM-5 （PCL-5）， Multidimensional Scale of Perceived Social Support （MSPSS） and UCLA Loneliness Scale （ULS-3）. Then the scores of above scales were compared among middle school students with different demographic characteristics， and binary Logistic regression analysis was conducted to screen the influencing factors of post-traumatic stress disorder (PTSD） symptoms. ResultsAmong the respondents， 17.71% （95% CI： 0.133~0.221）， 8.68% （95% CI： 0.054~0.120）， 2.78% （95% CI： 0.009~0.047） and 45.83% （95% CI： 0.400~0.516） were reported to have symptoms of depression， anxiety， PTSD and loneliness， respectively. Students in senior middle school scored lower on PCL-5 and ULS-3 than those in junior middle school ［（6.46±8.91） vs. （8.87±9.42）， t=2.202， P<0.05； （4.67±1.65） vs. （5.60±1.88）， t=4.431， P<0.01］. Regression analysis denoted that depressive symptoms （OR=7.630， P<0.05） and anxiety symptoms （OR=3.789， P<0.01） were risk factors for PTSD symptoms among middle school students. ConclusionThe middle school students in Xide County， Liangshan Yi Autonomous Prefecture suffer a high prevalence rate of depressive symptoms and loneliness， and those in junior middle school are more likely to feel a sense of strong loneliness， furthermore， depressive symptoms and anxiety symptoms are risk factors for PTSD symptoms.

Objective:In order to explore the impact of corona virus disease 2019(COVID-19)on the hospitalization of children with bronchiolitis and to improve clinicians′ understanding of the characteristics of bronchiolitis during the COVID-19 epidemic.Methods:This was a multicenter clinical study, and the data have been collected from 23 children′s medical centers in China.All the clinical data were retrospectively collected from children with bronchiolitis who were hospitalized at each study center from January 1, 2019 to December 31, 2021.The results included gender, age at hospitalization, length of stay, respiratory syncytial virus(RSV) test results, severity rating, ICU treatment, and the total number of children hospitalized with respiratory tract infection during the same period.The clinical data of children with bronchiolitis in 2019 before COVID-19 epidemic and in 2020、2021 during COVID-19 epidemic were statistically analyzed and compared.Results:According to a summary of data provided by 23 children′s medical centers, there were 4 909 cases of bronchiolitis in 2019, 2 654 cases in 2020, and 3 500 cases in 2021.Compared with 2019, the number of bronchiolitis cases decreased by 45.94% in 2020 and 28.70% in 2021.In 2019, 2020 and 2021, there were no significant differences in gender ratio, age, and duration of hospitalization.Compared with 2019, the ratio of bronchiolitis to the total number of hospitalizations for respiratory tract infection decreased significantly in 2020 and 2021( χ2=12.762, P<0.05; χ2=84.845, P<0.05).The proportion of moderate to severe bronchiolitis cases in both 2020 and 2021 was lower than that in 2019, and the difference was statistically significant ( χ2=4.054, P<0.05; χ2=8.109, P<0.05).There was no statistically significant difference in the proportion of bronchiolitis cases requiring ICU treatment between 2019, 2020, and 2021 ( χ2=1.914, P>0.05).In 2019, a total of 52.60%(2 582/4 909) of children with bronchiolitis underwent RSV pathogen testing, and among them, there were 708 cases with RSV positive, accounting for 28.00%.In 2020, 54.14%(1 437/2 654) of children with bronchiolitis underwent RSV pathogen testing, and there were 403 cases with RSV positive, accounting for 28.04%.In 2021, 66.80%(2 238/3 500) of children with bronchiolitis underwent RSV pathogen testing, and there were 935 cases with RSV positive, accounting for 41.78%.Compared with 2019 and 2020, the RSV positive rate in 2021 showed a significant increase( χ2=99.673, P<0.05; χ2=71.292, P<0.05). Conclusion:During the COVID-19 epidemic, the implementation of epidemic prevention and control measures reduced the hospitalization rate and severity of bronchiolitis, but did not reduce the positive rate of RSV detection.

OBJECTIVE To compare the components of volatile oil from Gardenia jasminoides and their liver protective effect before and after stir-frying with wine. METHODS Steam distillation was used to exact the volatile oil from G. jasminoides and wine stir-fried G. jasminoides. The components of volatile oil were identified by GC-MS method， and the relative mass fraction of each component was calculated by peak area normalization method. The rats were randomly divided into normal group， model group， positive control group （bifendate suspension 35 mg/kg）， G. jasminoides low-dose and high-dose groups [1， 2 g/kg （calculated by crude drug）] and wine stir-fried G. jasminoides low-dose and high-dose groups [1， 2 g/kg （calculated by crude drug）] with 10 rats in each group. Liver injury model was established by intraperitoneal injection of 40% carbon tetrachloride in rats of each group after continuous intragastric administration of corresponding drug solution for 7 days. The status， serum biochemical indexes， liver biochemical indexes and liver pathological sections of rats in each group were compared. RESULTS Twenty-three volatile oil components from G. jasminoides and 25 volatile oil components from wine stir-fried G. jasminoides were identified； there were 18 common volatile oil components， of which the contents of 17 common components were decreased， while the content of one common component was increased due to stir-frying with wine. Compared with model group， the symptoms of depression and liver cell damage of rats in each administration group were improved to varying degrees； the serum levels of adenosine deaminase， alanine transaminase， aspartate transaminase， direct bilirubin， lactate dehydrogenase，prealbumin， total bile acid and total bilirubin were significantly decreased， while the total protein level was significantly increased； the level of malondialdehyde in liver tissue was significantly decreased， there were statistical significance （P＜0.05 or P＜0.01）. CONCLUSIONS During stir-frying with wine， the contents of 17 volatile oil components are decreased， while the content of one volatile oil component is increased. Wine stir-fried G. jasminoides shows liver protective effect. .

Objective:To explore the value of subspecialty group collaboration combined with disease checklist-driven learning in overcoming the impact of the specialized disease treatment mode in subspecialty establishment on the cultivation of professional postgraduate students.Methods:In the teaching of general surgery and gastroenterology, sixty professional postgraduate students of grade 2019 were randomly divided into control group and experimental group, with 30 students in each group. The control group received traditional teaching, while the experimental group received the teaching mode of subspecialty group collaboration combined with disease checklist-driven learning. The teaching effectiveness and the degree of satisfaction with teaching were compared between the two groups. The data were analyzed using the t test and the chi-squared test using SPSS 20.0. Results:In actual teaching, compared with the control group, the experimental group showed significantly higher scores of theoretical assessment (71.51±11.32 vs. 87.23±10.51, P<0.05) and case analysis (73.61±6.82 vs. 92.37±6.87, P<0.05). The rates of satisfaction with theoretical knowledge learning, application of clinical thinking ability for diseases, teaching organization forms, and teaching effectiveness were 90.00%(27/30), 86.67%(26/30), 96.67%(29/30), and 93.33%(28/30) in the experimental group, respectively, which were significantly higher than those of the control group [40.00%(12/30), 23.33%(7/30), 40.00%(12/30), and 46.67%(14/30), respectively; all P<0.05]. Conclusions:The subspecialty group collaboration combined with disease checklist-driven learning mode can overcome the problems of "narrow disease spectrum and narrow knowledge scope" in specialized postgraduate education, and guide students to break the teaching barriers generated by subspecialty construction to create a new form of comprehensive and multi-disease learning, with good prospects for promotion and application.

Objective:To explore the current situation of moderate and severe postoperative procedural pain in surgical Intensive Care Unit (ICU) patients and analyze its influencing factors.Methods:This study was a cross-sectional study. From June 2021 to February 2022, 380 postoperative patients admitted to the surgical ICU of West China Hospital of Sichuan University were selected by convenient sampling as the research object. A self-designed Postoperative Procedural Pain Questionnaire for ICU Patients and the Numerical Rating Scale (NRS) were used to investigate the patients. Binomial Logistic regression was used to explore the influencing factors of moderate and severe postoperative procedural pain.Results:The incidence of moderate and severe postoperative procedural pain in 380 ICU patients was 72.63% (276/380) . A total of 52.17% (144/276) patients actively reported moderate and severe procedural pain, and 47.83% (132/276) patients chose to conceal or endure moderate and severe procedural pain. The results of binomial Logistic regression showed that gender ( OR=13.763, P<0.01) , history of chronic pain ( OR=2.363, P<0.05) , number of drainage tubes ( OR=1.297, P<0.01) , and the score of Acute Physiology and Chronic Health Evaluation ( OR=4.137, P<0.01) were the influencing factors for surgical ICU patients to have moderate and severe postoperative procedural pain. Conclusions:The incidence of moderate and severe postoperative procedural pain in ICU patients is high. Medical and nursing staff should formulate targeted interventions according to the influencing factors of patients ' procedural pain.

Objective:To search, screen, and summarize the best evidence-based evidence for procedural pain management in adult patients in the Intensive Care Unit (ICU), so as to provide reference for clinical practice.Methods:Guidelines, clinical decisions, expert consensus, systematic reviews, and randomized controlled trial (RCT) on procedural pain management for adult patients in ICU were searched in domestic and foreign databases, guide websites, and professional association websites. The search time limit was from the establishment of the database to August 31, 2022.Results:A total of 14 articles were included, including six guidelines, three RCTs, three systematic reviews, and two clinical decisions. A total of 8 themes and 27 best evidence were extracted.Conclusions:It is recommended that clinical medical and nursing personnel provide personalized and multimodal procedural pain intervention measures for adult patients in ICU in a timely manner in accordance with the medication principles of procedural pain management, in order to improve the procedural pain experience of ICU patients and the quality of nursing.

To explore the potential associations between perceived stress and health-promoting behaviors based on the theoretical schema of the middle-range theory of adaptation to chronic illness. From January to May 2021, a convenience sampling method was used to recruit 230 young and middle-aged patients with metabolic syndrome who underwent physical examination in the inpatient center of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine. The Health-Promoting Health Profile-Ⅱ, Chinese Perceived Stress Scale, Coping and Adaptation Processing Scale-Short Form, and Multi-dimensional Scale of Perceived Social Support were used in the cross-sectional study. The chain mediation effect procedure and bootstrap sampling test were used to examine the mediating role of adaptability and social support between perceived stress and health-promoting behaviors. The mean score of health-promoting behaviors was 100.0±14.6, the mean score of perceived stress was 22.0± 6.9, the mean score of adaptability was 47.0±6.1, and the mean score of social support was 63.8±10.8. Perceived stress had a negative impact on patients' health-promoting behaviors (=-0.309, <0.05). The adaptability (effect size= -0.112, 95%:-0.199~-0.038) and social support (effect size= -0.032, 95%:-0.083~played a mediating role and a chain mediating role in the process of perceived stress influencing patients' health-promoting behaviors (effect size= -0.045, 95%:-0.093~-0.020). Adaptability and social support play an intermediary role between perceived stress and health-promoting behaviors in young and middle-aged patients with metabolic syndrome. Healthcare professionals can motivate patients to develop healthy behaviors by developing intervention strategies on adaptability and social support.
Adaptation, Psychological ; Cross-Sectional Studies ; Humans ; Metabolic Syndrome ; Middle Aged ; Social Support ; Stress, Psychological

To design and develop a Wechat applet for intelligent health management of metabolic syndrome. Based on the needs and requirements of individuals undergoing health check-up, patients with metabolic syndrome and medical workers, a Wechat applet for metabolic syndrome management was designed and developed, which involving health data collection, health risk prediction, health management knowledge base fusion and intelligent recommendation, data privacy and security. The platform consists of three user ports: individuals undergoing health check and patients with metabolic syndrome, the medical workers and the system administrators. The main functions of the platform included metabolic syndrome risk prediction, intelligent recommendation of health management strategies, health behavior record and supervision, experts' consultation and health knowledge guide. The Wechat applet developed in this study can be used for metabolic syndrome risk prediction for general population, and health management for patients with metabolic syndrome, which helps them to enhance health management awareness and health behavior adherence.
Humans ; Metabolic Syndrome/therapy* ; Software