This paper summarizes Professor LU Fang's clinical experience in treating systemic lupus erythematosus （SLE） based on the differentiation and treatment of heat-toxin and blood-stasis in the collaterals. SLE is generally characterized by deficiency in origin with excess in manifestation. The core pathogenesis is heat-toxin obstructing the collaterals. During the acute active stage， the predominant pattern is blazing heat-toxin causing blood stasis， while in the chronic remitting stage， the main pattern is toxic stasis blocking the collaterals with qi and yin deficiency. Clinical treatment follows the basic principle that treat with salty-cold herbs， when heat invades internally and that assist with acrid-dispersing herbs when stasis obstructs the collaterals. The self-formulated Yimian Decoction （抑免汤） serves as the base formula and is applied in stages. During the acute active stage， it is often combined with herbs for clearing heat and detoxifying， cooling blood and resolving stasis， and unblocking the collaterals. In the chronic remitting stage， it is often combined with herbs for activating blood circulation and unblocking the collaterals， as well as tonifying qi and nourishing yin.

Objective To evaluate the caregiving capacity of family caregivers of children with hirschsprung's disease(HD)and to establish an evidence base for developing family-empowered home care interventions.Methods An explanatory sequential mixed-method design was employed.A total of 308 family caregivers of HD patients admitted to the Pediatric Surgery Department of a tertiary children's hospital in Shanghai,were enrolled from July 2019 to July 2024.Quantitative data were collected in 2024 using a demographic questionnaire,the Zarit Caregiver Burden Interview and the Family Caregiver Task Inventory.Semi-structured interviews were conducted in August to December 2024 with 15 caregivers of children with HD with poor caregiving skills.Quantitative data were analyzed using nonparametric tests and multiple linear regression,and qualitative information was refined through Colaizzi's 7-step analysis of themes.Results In the end,281 valid questionnaires were recovered.The total caregiving competence was 12.00(6.00,20.00).Multivariate analysis identified significant predictors of caregiving competence,including children in the postoperative dilation period,frequency of enterocolitis episodes,place of residence monthly household income and burden of caregiving were the factors influencing the ability of family caregivers to take care of their children(P＜0.05).Qualitative analysis revealed 4 themes:persistent multidimensional adaptive challenges,disparity in clinical caregiving skills,systemic support limitations,and role multiplicity strain.Conclusion Family caregivers of children with HD face multidimensional stressors,necessitating a dynamic,family-centered support ecosystem.Strategic interventions should focus on enhancing clinical caregiving literacy while improving access to socioeconomic resources and establishing role-specific support networks.

Objective:To explore the safety and effectiveness of ileal bypass with stent to prevent anastomotic leakage in Da Vinci robot anus-preserving surgery for low rectal cancer.Methods:From Dec 2021 to Sep 2024, the clinical data of 55 patients undergoing robot anus-preserving surgery and stent ileal bypass for low rectal cancer in the First Affiliated Hospital of Ningbo University was analyzed retrospectively.Results:All the 55 patients successfully completed the operation. Among them, 47 patients underwent low anterior resection and 8 patients did sphincter resection. The total operation time was (207±37)min, the operation time of ileal bypass was (24±3)min, and the intraoperative blood loss was (32±18)ml. After operation, the time of stent disintegration was (23.93± 2.87) days, and the time of catheter removal was (29.55 ± 3.21) days. By postoperative TNM staging, there were 12 cases in T1 stage, 26 cases in T2 and 17 cases in T3. The number of lymph node dissection was (16.84±4.50), 15 cases being positive for lymph node metastasis, 40 cases being negtive for lymph node metastasis, 36 cases were stage Ⅰ, 4 cases were stage Ⅱ and 15 cases were stage Ⅲ. The median follow-up time was 20 (2-35) months. Delayed anastomotic leakage occurred in 1 patient and anastomotic stenosis occurred in 2 patients.Conclusion:Stent ileal bypass is safe and effective to prevent anastomotic leakage in Da Vinci robot anus-preserving surgery for low rectal cancer.

Objective To evaluate the caregiving capacity of family caregivers of children with hirschsprung's disease(HD)and to establish an evidence base for developing family-empowered home care interventions.Methods An explanatory sequential mixed-method design was employed.A total of 308 family caregivers of HD patients admitted to the Pediatric Surgery Department of a tertiary children's hospital in Shanghai,were enrolled from July 2019 to July 2024.Quantitative data were collected in 2024 using a demographic questionnaire,the Zarit Caregiver Burden Interview and the Family Caregiver Task Inventory.Semi-structured interviews were conducted in August to December 2024 with 15 caregivers of children with HD with poor caregiving skills.Quantitative data were analyzed using nonparametric tests and multiple linear regression,and qualitative information was refined through Colaizzi's 7-step analysis of themes.Results In the end,281 valid questionnaires were recovered.The total caregiving competence was 12.00(6.00,20.00).Multivariate analysis identified significant predictors of caregiving competence,including children in the postoperative dilation period,frequency of enterocolitis episodes,place of residence monthly household income and burden of caregiving were the factors influencing the ability of family caregivers to take care of their children(P＜0.05).Qualitative analysis revealed 4 themes:persistent multidimensional adaptive challenges,disparity in clinical caregiving skills,systemic support limitations,and role multiplicity strain.Conclusion Family caregivers of children with HD face multidimensional stressors,necessitating a dynamic,family-centered support ecosystem.Strategic interventions should focus on enhancing clinical caregiving literacy while improving access to socioeconomic resources and establishing role-specific support networks.

Objective:To explore the safety and effectiveness of ileal bypass with stent to prevent anastomotic leakage in Da Vinci robot anus-preserving surgery for low rectal cancer.Methods:From Dec 2021 to Sep 2024, the clinical data of 55 patients undergoing robot anus-preserving surgery and stent ileal bypass for low rectal cancer in the First Affiliated Hospital of Ningbo University was analyzed retrospectively.Results:All the 55 patients successfully completed the operation. Among them, 47 patients underwent low anterior resection and 8 patients did sphincter resection. The total operation time was (207±37)min, the operation time of ileal bypass was (24±3)min, and the intraoperative blood loss was (32±18)ml. After operation, the time of stent disintegration was (23.93± 2.87) days, and the time of catheter removal was (29.55 ± 3.21) days. By postoperative TNM staging, there were 12 cases in T1 stage, 26 cases in T2 and 17 cases in T3. The number of lymph node dissection was (16.84±4.50), 15 cases being positive for lymph node metastasis, 40 cases being negtive for lymph node metastasis, 36 cases were stage Ⅰ, 4 cases were stage Ⅱ and 15 cases were stage Ⅲ. The median follow-up time was 20 (2-35) months. Delayed anastomotic leakage occurred in 1 patient and anastomotic stenosis occurred in 2 patients.Conclusion:Stent ileal bypass is safe and effective to prevent anastomotic leakage in Da Vinci robot anus-preserving surgery for low rectal cancer.

Objective To investigate the molecular mechanisms by which SOX7 regulates the SHP-2/Wnt/β-cate-nin/ROS pathway,affecting the proliferation,invasion,and migration of colorectal cancer cells.Methods Twenty nude mice with subcutaneously transplanted tumor models were randomly divided into four groups:SOX7 NC(n=5),SOX mimic(n=5),SOX7 NC+PHPS1(n=5),and SOX7 mimic+PHPS1(n=5)to observe tumor growth.Human colorectal cancer cell line SW480 cells were transfected via lipofection and divided into six groups:SOX7 NC,SOX7 mimic,SOX7 NC+H2 O2,SOX7 mimic+H2O2,SOX7 NC+PHPS1,and SOX7 mimic+PHPS1.The ex-pression of SHP-2/Wnt/β-catenin/ROS pathway-related proteins in SW480 cells of each group was detected by Western blot.The invasion and migration capabilities of SW480 cells were assessed through scratch and Transwell invasion assays,while cell proliferation was evaluated using CCK-8.Results In vivo experiments demonstrated that tumors in the SOX7 mimic group were significantly smaller than those in the SOX7 NC group(P＜0.01).Tumors treated with PHPS1 intervention exhibited a significant increase in volume.There was no statistical significance in the difference in tumor volume between the SOX7 mimic+PHPS1 group and the SOX7 NC+PHPS1 group.In vitro experiments revealed that SOX7 mimic inhibited the expression of Wnt,β-catenin,NOX2,NOX4,PI3K,P-PI3K,AKT,P-AKT proteins(P＜0.01),and promoted the expression of p-SHP-2 protein(P＜0.01).The addition of hydrogen peroxide and SHP-2 inhibitor reversed the effects of SOX7 on SW480 cells(P＜0.05),and significantly promoted the expression levels of Wnt,β-catenin,NOX2,NOX4,PI3K,P-PI3K,AKT,P-AKT proteins,with no sig-nificant difference,while significantly reducing the expression levels of SHP-2,p-SHP-2 proteins,with no significant difference.PHPS1 inhibited the expression of SHP-2,p-SHP-2 proteins(P＜0.05)and upregulated the expression of Wnt,β-catenin,NOX2,NOX4,PI3K,P-PI3K,AKT,P-AKT proteins(P＜0.05).Scratch,Transwell invasion and migration assays,and CCK-8 experiments indicated that SOX7 suppressed the migration,invasion,and proliferation of SW480 cells through oxidative stress and the SHP-2 pathway(P＜0.01),while H2O2 and PHPS1 intervention promoted the migration,invasion,and proliferation of SW480 cells(P＜0.05).Conclusion SOX7 can suppress the proliferation,invasion,and migration of colorectal cancer by targeting the SHP-2/Wnt/β-catenin/ROS pathway.

Objective:To evaluate the safety and feasibility of robot assisted total gastrectomy plus hand-sewn esophagojejunostomy.Methods:The clinical data of 72 patients diagnosed with gastric cancer and undergoing total gastrectomy at the First Affiliated Hospital of Ningbo University from Nov 2021 to May 2024 were retrospectively analyzed. They were divided into two groups: robot-assisted total gastrectomy (RATG) group, consisting of 30 patients, and laparoscopic assisted total gastrectomy (LATG) group, consisting of 42 patients . In the RATG group, the digestive tract was reconstructed by manual suture under the robot scope and Roux-Y reconstruction was performed . In LATG group, digestive tract reconstruction was performed using an in vitro stapler and Roux-Y. The clinicopathological data, perioperative indexes, and postoperative follow-up data of both groups were observed and analyzed.Results:All 72 patients successfully completed the operation without conversion to open laparotomy. The total operation time in RATG group was longer than that in LATG group [(235.2±25.8) min vs. (200.7±40.6) min, t=4.099, P<0.05)].RATG was superior to LATG group in terms of digestive tract reconstruction time, postoperative fluid intake time and hospitalization days,the difference was statistically significant [(36.9±3.0) min vs.(39.4±4.5) min, (4.2±0.5) d vs. (5.2±0.6) d、(9.5±1.6) d vs. (10.8±2.4)d, t=-2.554,-7.135,-2.595, all P<0.05]; In terms of postoperative pathology, the number of lymph node dissection in RATG group was higher than that in LATG group [(29.8±6.2) vs. (26.3±7.5), t=2.197, P<0.05]. Conclusion:The application of delayed disconnection hand-sewn esophagojejunostomy in Da Vinci robot total gastrectomy is safe and feasible for cure-intent total gastrectomy in patients of gastric carcinoma.

Objective:To evaluate the practical effect of online teaching based on reflective experience to promote the cultivation of professional core competence of nursing.Methods:A total of 160 intern nurses who entered the clinic from July 2019 to December 2019 in The Affiliated Hospital of Inner Mongolia Medical University were selected as the research subjects, and they were randomized into a control group and an experimental group, with 80 nurses in each group. Both groups were given the creation of clinical practice teaching online classroom under the existing nursing online teaching framework. The control group conducted general online course education, and the experimental group created a problem-solving reflective experience course task and teaching process from the core competence training content of nursing. After the internship, the core competence assessment of the standardized training for nursing major was conducted, and the difference in teaching was evaluated using the "Nurse Core Competency Scale" and the self-designed "Teaching Acceptance Questionnaire". SPSS 22.0 was used for t-test and Chi-square test. Results:The excellent rates of the professional theory and practical skills assessments of the students in the experimental group were 58.75% (47/80) and 51.25% (41/80), which were higher than those in the control group, 48.75% (39/80) and 31.25% (25/80). The differences between the two groups were statistically significant ( P<0.05). In the comparison of the "Core Competency Scale" of nurses between the two groups of nurse students, the total score of the experimental group and the score of each dimension were significantly higher than those of the control group ( P<0.05). They survey of "Teaching Acceptance Questionnaire" showed that the nursing students of the experimental group had higher recognition of the teaching methods of this group, and there were significant differences between the two groups ( P<0.05). Conclusion:Carrying out online training content of clinical practice teaching based on reflective experience is conducive to the establishment of core competence of nursing students and the improvement of clinical practice ability.

Schistosomiasis cystitis is a urogenital system disease caused by Schistosoma aegypt. Common clinical manifestations are frequent urination, urgency, dysuria, and terminal hematuria, but new infections can be asymptomatic. Detection of parasite eggs by urine microscopy is considered to be the gold standard for diagnosis, but the result may be a false negative in the inactive period. The main epidemic of this disease is located in Africa and the Middle East area. However, in china, there are few reports of confirmed cases. This article reports a case of imported schistosomiasis cystitis. The patient is a Sudanese, male, who has been studying in China for more than 2 years, mainly with persistent painless hematuria for more than 6 months. Cystoscopy was proposed to diagnose a bladder mass, and schistosomiasis cystitis was confirmed by pathological diagnosis after surgery.

Objective:To compare the clinical value of stent assisted intestinal bypass and temporary loop ileostomy in laparoscopic low anterior resection of rectal cancer.Method:In this retrospective analysis, 57 patients undergoing laparoscopic low anterior resection for rectal cancer in the First Affiliated Hospital of Ningbo University from Jan 2020 to Jan 2022 were divided into intestinal bypass group (36 cases) and loop ileostomy group (21 cases).Result:There were no significant differences in postoperative GI function recovery and postoperative complication rate between the two groups (all P>0.05). The levels of albumin, prealbumin and hemoglobin in the intestinal bypass group were better than those in the ileostomy group when evaluated on 3rd months after operation [(40.5±2.3) g/L vs. (38.1±2.6)g/L、(26.4±2.7)mg/dl vs. (24.5±2.0)mg/dl、(137.6±5.9) g/L vs. (134.0±7.0) g/L, t=3.605、2.743、2.085, all P<0.05]. Hospital expenses of the intestinal bypass group was lower [(571 000±7 500) yuan vs. (69 300±9 100) yuan, t=-5.477, P<0.05]. Conclusion:Compared with traditional ileostomy, the stent assisted intestinal bypass reduces trauma with lower expenses and improves patients' status after laparoscopic low anterior resection for rectal cancer.