Objective To explore the application of problem solving mode based on self-regulation theory in maintenance hemodialysis(MHD)patients.Methods The convenient sampling method was used to enroll the patients who underwent hemodialysis in Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January to October 2022.According to the random number table,they were assigned to the control group or observation group.Routine nursing was used in the control group,and the nursing care of problem-solving mode based on self-regulation theory was applied in the observation group for 4 week.Self-management behavior,volume management behavior,disease perception and learned helplessness were compared between the two groups at 4 and 12 weeks after intervention.Results Eight patients(5 cases in the control group and 3 cases in the observation group)failed to be followed up.There was no significant difference in the score of self-management behavior,volume management behavior,disease perception or learned helplessness between the two groups before the intervention(P＞0.05).At 4 and 12 weeks after the intervention,the scores of self-management behavior and volume management behavior in the observation group were significantly higher than those in the control group,while the scores of disease perception and learned helplessness in the observation group were significantly lower than those in the control group(P＜0.05).Conclusion The problem-solving mode based on self-regulation theory can improve self-management and volume management of MHD patients,reduce negative disease perception and learning helplessness,and achieve continuous improvement in cognition,psychology and behavior after the intervention.

Objective:To analyze the differences in emergency rescue service capacities between county-level hospitals in Zhejiang and Jiangsu provinces, and propose targeted improvement suggestions.Methods:Cluster sampling was employed, with representative county-level hospitals recommended by provincial hospital alliances in Zhejiang and Jiangsu. Emergency departments voluntarily submitted data, resulting in 24 hospitals from Zhejiang and 34 from Jiangsu. Data were collected through the China County-Level Hospital Emergency Service Capability Evaluation System. Differences between provinces were analyzed. Spearman correlation analysis explored relationships between multidimensional indicators, and multivariate logistic regression identified factors influencing hospital grade B++ and above.Results:In terms of department scale, Jiangsu had a larger emergency department area (4 853 m 2vs. 1 927 m 2, P<0.001), more beds of comprehensive inpatient wards in the emergency department (25.5 beds vs. 5.5 beds, P=0.011), and higher scores for the ratio of emergency department area to beds (4.8 vs. 3.4, P=0.005) than Zhejiang. In terms of staffing, Jiangsu had a higher proportion of doctors with master's degrees or above (13.8% vs. 0.0%, P<0.001), a higher proportion of frontline emergency medical staff with over three years of clinical experience (100.0% vs. 91.5%, P=0.001), and more doctors (19 vs. 15, P=0.039) and nurses (46 vs. 32, P=0.039). In terms of quality and safety and medical service capacity, Zhejiang had a higher severe trauma resuscitation success rate (92.9% vs. 83.75%, P=0.003), annual emergency surgery volume (1 002 vs. 428, P=0.015), and number of emergency surgery procedures (125 vs. 42, P=0.027), but Jiangsu had a shorter emergency room stay time (87.5 min vs. 136.2 min, P=0.029). In terms of informatization, Zhejiang outperformed Jiangsu in all indicators, especially in patient information interconnection and sharing (100.0% vs. 82.4%, P=0.030) and in-hospital diagnosis and treatment timeline (91.7% vs. 73.5%, P=0.043). Correlation analysis showed that the total specialty scale score was significantly positively correlated with the in-hospital emergency rescue service capacity score ( r=0.576) and the staffing score ( r=0.455). The total evaluation score was significantly positively correlated with the informatization total score ( r=0.397) and the pre-hospital emergency rescue service capacity score ( r=0.322). Binary Logistic regression analysis showed that the emergency rescue service capacity score was significantly positively correlated with hospital grade ( B=1.431, P=0.03, OR=4.185, 95% CI:1.152-15.205). For every 1-unit increase in the emergency department area ( B=0.002, P=0.05), the probability of a hospital being upgraded to B++ or above increased by 0.2% ( OR=1.002, 95% CI:1.000-1.004). Conclusions:Both provinces exhibit distinct advantages in emergency department development. Departmental scale and configuration significantly impact emergency service capabilities, while staffing and quality management constitute core elements for improvement. Informatization construction notably enhances emergency service efficiency and quality.

Objective:To investigate the heterogeneity of tumor density-enhancement complex (TDEC) based on MRI parameters in predicting the treatment response and prognosis for recurrent glioblastoma (rGBM) to guide the formulation of personalized clinical treatment strategies.Methods:A prospective cohort study was performed; 66 patients with postoperative rGBM were enrolled from Department of Neurosurgery, Affiliated Hospital of Jiangsu University. Multi-sequence MRI was performed, and diffused and enhanced data of the rGBM were utilized to construct TDEC as intratumoral sub-regions via pixel co-localization technique. Correlations among rGBM with different volume proportions of TDEC types and correlations of rGBM with different volume proportions of TDEC types with rGBM volume were analyzed in rGBM after bevacizumab (BEV) combined with radiotherapy. A pixel co-localization decoupling method was applied to assess the treatment response efficiency in individual TDEC subcomponents. The rGBM imaging phenotypes were identified through unsupervised clustering analysis, and progression-free survival (PFS) and overall survival (OS) between patients with different phenotypes were compared. The predictive value of TDEC heterogeneity in PFS and OS of rGBM patients under BEV plus radiotherapy was assessed. Results:Four distinct TDEC sub-regions (TDEC1-4) were identified; a significant negative correlation was observed between volume proportions of TDEC2 and TDEC3 ( r s=-0.558, P<0.001), as well as between volume proportions of TDEC3 and TDEC4 ( r s=-0.782, P<0.001), while TDEC composition (volume proportions of TDEC2-4) showed no significant correlation with tumor volume ( P>0.05). Following BEV combined with radiotherapy, significant sub-region-specific TDEC volume changes were observed (tumor volume minification rate of TDEC1[ΔV TDEC1]: 16.7% [13.8%, 20.1%]; ΔV TDEC2: 25.4% [21.9%, 29.0%]; ΔV TDEC3: 27.6% [23.5%, 31.2%]; ΔV TDEC4: 8.4% [6.1%, 10.7%], P<0.05); volume proportion of TDEC3 was positively correlated with tumor volume minification ( r s=0.702, P<0.001), whereas volume proportion of TDEC4 was negatively correlated tumor volume minification ( r s=-0.933, P<0.001). The volume reduction of TDEC1-3 was driven by combined effects of tumor cellular and enhancement components, while volume reduction of TDEC4 was primarily attributed to changes in tumor cellularity (ΔV ADC: 9.3%; ΔV T1C: 0.8%). Two distinct TDEC phenotypes with different survival outcomes were identified in rGBM patients (silhouette coefficient=0.584; TDEC type I: n=23; type II: n=43); significant difference in PFS and OS was noted between patients with TDEC type I and type II (PFS: χ2=11.191, P=0.001; OS: χ2=9.733, P=0.002). TDEC phenotype was an independent influencing factor for survival of rGBM patients under BEV combined with radiotherapy (PFS: HR=2.738, 95% CI: 1.815-3.938 , P=0.003; OS: HR=2.507, 95% CI: 1.851-3.660, P=0.007). Conclusion:TDEC sub-region helps efficiently characterize the rGBM heterogeneity; rGBM imaging phenotypes identified based on TDEC sub-region can independently predict the clinical outcomes: the prognosis of TDEC type I patients is better than that of TDEC type II patients.

Objective:To investigate the dose-effect relationship between sedentary time and sarcopenia in maintenance hemodialysis (MHD) patients, and to inform decision-making to improve muscle health in MHD patients.Methods:A retrospective cohort study was conducted. MHD patients undergoing dialysis in Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2021 to December 2023 were selected by convenience sampling method. Data on general information, prevalence of sarcopenia and sedentary time, etc. were collected. Based on the quartile of sedentary time, MHD patients were categorized into group Q1 (sedentary time<3.40 h), group Q2 (3.40 h≤sedentary time<5.20 h), group Q3 (5.20 h≤sedentary time<9.33 h) and group Q4 (sedentary time≥9.33 h). Restricted cubic spline plots were used to analyze the dose-effect relationship between sedentary time and the risk of sarcopenia. Logistic regression was used to analyze the relationship between sedentary time and the risk of sarcopenia with trend analysis. Subgroups were grouped according to age, gender, and age on dialysis, and subgroup analyses were performed using the interaction test.Results:A total of 576 MHD patients were enrolled, 272 males and 304 females, age (59.69 ± 11.38) years, the sedentary time was 5.20 (3.40, 9.33) h, and the prevalence of sarcopenia was 31.60% (182/576). Restricted cubic spline plots analysis showed that there was a trend of linear association between sedentary time and the risk of sarcopenia ( Pnon-linear=0.226), with a positive correlation ( Poverall<0.01). Logistic analysis showed that when correcting for all confounding factors, compared with group Q1, the risk of sarcopenia increased 1.557 times in group Q3 ( OR=2.557, 95% CI 1.255-5.334, P<0.01) and 7.721 times in group Q4 ( OR=8.721, 95% CI 4.328-18.323, P<0.01). And the OR values of sarcopenia in sedentary time of group Q1, Q2, Q3, and Q4 showed an increasing trend ( Ptrend<0.01). Subgroup analysis showed that the relationship between the risk of sarcopenia and sedentary time was basically the same in MHD patients of different age, gender, and dialysis age subgroups ( OR values were 1.807-3.090, all P<0.05), and there was no interaction between sedentary time and age, gender, and dialysis age (all Pinteraction>0.05). Conclusions:The longer the sedentary time, the higher the risk of sarcopenia in MHD patients. And the risk of sarcopenia was higher for sedentary time ≥ 5.20 h. Medical staffs should encourage MHD patients to improve their living habits, especially those who sit for more than 5.20 h a day, to prevent sarcopenia.

Objective:To investigate the dose-effect relationship between sedentary time and sarcopenia in maintenance hemodialysis (MHD) patients, and to inform decision-making to improve muscle health in MHD patients.Methods:A retrospective cohort study was conducted. MHD patients undergoing dialysis in Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2021 to December 2023 were selected by convenience sampling method. Data on general information, prevalence of sarcopenia and sedentary time, etc. were collected. Based on the quartile of sedentary time, MHD patients were categorized into group Q1 (sedentary time<3.40 h), group Q2 (3.40 h≤sedentary time<5.20 h), group Q3 (5.20 h≤sedentary time<9.33 h) and group Q4 (sedentary time≥9.33 h). Restricted cubic spline plots were used to analyze the dose-effect relationship between sedentary time and the risk of sarcopenia. Logistic regression was used to analyze the relationship between sedentary time and the risk of sarcopenia with trend analysis. Subgroups were grouped according to age, gender, and age on dialysis, and subgroup analyses were performed using the interaction test.Results:A total of 576 MHD patients were enrolled, 272 males and 304 females, age (59.69 ± 11.38) years, the sedentary time was 5.20 (3.40, 9.33) h, and the prevalence of sarcopenia was 31.60% (182/576). Restricted cubic spline plots analysis showed that there was a trend of linear association between sedentary time and the risk of sarcopenia ( Pnon-linear=0.226), with a positive correlation ( Poverall<0.01). Logistic analysis showed that when correcting for all confounding factors, compared with group Q1, the risk of sarcopenia increased 1.557 times in group Q3 ( OR=2.557, 95% CI 1.255-5.334, P<0.01) and 7.721 times in group Q4 ( OR=8.721, 95% CI 4.328-18.323, P<0.01). And the OR values of sarcopenia in sedentary time of group Q1, Q2, Q3, and Q4 showed an increasing trend ( Ptrend<0.01). Subgroup analysis showed that the relationship between the risk of sarcopenia and sedentary time was basically the same in MHD patients of different age, gender, and dialysis age subgroups ( OR values were 1.807-3.090, all P<0.05), and there was no interaction between sedentary time and age, gender, and dialysis age (all Pinteraction>0.05). Conclusions:The longer the sedentary time, the higher the risk of sarcopenia in MHD patients. And the risk of sarcopenia was higher for sedentary time ≥ 5.20 h. Medical staffs should encourage MHD patients to improve their living habits, especially those who sit for more than 5.20 h a day, to prevent sarcopenia.

Objective:To investigate the heterogeneity of tumor density-enhancement complex (TDEC) based on MRI parameters in predicting the treatment response and prognosis for recurrent glioblastoma (rGBM) to guide the formulation of personalized clinical treatment strategies.Methods:A prospective cohort study was performed; 66 patients with postoperative rGBM were enrolled from Department of Neurosurgery, Affiliated Hospital of Jiangsu University. Multi-sequence MRI was performed, and diffused and enhanced data of the rGBM were utilized to construct TDEC as intratumoral sub-regions via pixel co-localization technique. Correlations among rGBM with different volume proportions of TDEC types and correlations of rGBM with different volume proportions of TDEC types with rGBM volume were analyzed in rGBM after bevacizumab (BEV) combined with radiotherapy. A pixel co-localization decoupling method was applied to assess the treatment response efficiency in individual TDEC subcomponents. The rGBM imaging phenotypes were identified through unsupervised clustering analysis, and progression-free survival (PFS) and overall survival (OS) between patients with different phenotypes were compared. The predictive value of TDEC heterogeneity in PFS and OS of rGBM patients under BEV plus radiotherapy was assessed. Results:Four distinct TDEC sub-regions (TDEC1-4) were identified; a significant negative correlation was observed between volume proportions of TDEC2 and TDEC3 ( r s=-0.558, P<0.001), as well as between volume proportions of TDEC3 and TDEC4 ( r s=-0.782, P<0.001), while TDEC composition (volume proportions of TDEC2-4) showed no significant correlation with tumor volume ( P>0.05). Following BEV combined with radiotherapy, significant sub-region-specific TDEC volume changes were observed (tumor volume minification rate of TDEC1[ΔV TDEC1]: 16.7% [13.8%, 20.1%]; ΔV TDEC2: 25.4% [21.9%, 29.0%]; ΔV TDEC3: 27.6% [23.5%, 31.2%]; ΔV TDEC4: 8.4% [6.1%, 10.7%], P<0.05); volume proportion of TDEC3 was positively correlated with tumor volume minification ( r s=0.702, P<0.001), whereas volume proportion of TDEC4 was negatively correlated tumor volume minification ( r s=-0.933, P<0.001). The volume reduction of TDEC1-3 was driven by combined effects of tumor cellular and enhancement components, while volume reduction of TDEC4 was primarily attributed to changes in tumor cellularity (ΔV ADC: 9.3%; ΔV T1C: 0.8%). Two distinct TDEC phenotypes with different survival outcomes were identified in rGBM patients (silhouette coefficient=0.584; TDEC type I: n=23; type II: n=43); significant difference in PFS and OS was noted between patients with TDEC type I and type II (PFS: χ2=11.191, P=0.001; OS: χ2=9.733, P=0.002). TDEC phenotype was an independent influencing factor for survival of rGBM patients under BEV combined with radiotherapy (PFS: HR=2.738, 95% CI: 1.815-3.938 , P=0.003; OS: HR=2.507, 95% CI: 1.851-3.660, P=0.007). Conclusion:TDEC sub-region helps efficiently characterize the rGBM heterogeneity; rGBM imaging phenotypes identified based on TDEC sub-region can independently predict the clinical outcomes: the prognosis of TDEC type I patients is better than that of TDEC type II patients.

Background::The study aimed to clarify the characteristics of lymph node metastasis (LNM) and to compare the oncologic outcomes of minimally invasive esophagectomy (MIE) with open esophagectomy (OE) in terms of lymph node dissection (LND) in thoracic esophageal cancer patients.Methods::The data from esophageal cancer patients who underwent MIE or OE from January 2016 to January 2019 were retrospectively reviewed. The characteristics of LNM in thoracic esophageal cancer were discussed, and the differences in numbers of LND, LND rate, and LNM rate/degree of upper mediastinum between MIE and OE were compared.Results::For overall characteristics of LNM in 249 included patients, the highest rate of LNM was found in upper mediastinum, while LNM rate in middle and lower mediastinum, and abdomen increased with the tumor site moving down. The patients were divided into MIE ( n = 204) and OE groups ( n = 45). In terms of number of LND, there were significant differences in upper mediastinum between MIE and OE groups (8 [5, 11] vs. 5 [3, 8], P < 0.001). The comparative analysis of regional lymph node showed there was no significant difference except the subgroup of upper mediastinal 2L and 4L group (3 [1, 5] vs. 0 [0, 2], P < 0.001 and 0 [0, 2] vs. 0, P = 0.012, respectively). Meanwhile, there was no significant difference in terms of LND rate except 2L (89.7% [183/204] vs. 71.1% [32/45], P = 0.001) and 4L (41.2% [84/204] vs. 22.2% [10/45], P = 0.018) groups. For LNM rate of T3 stage, there was no significant difference between MIE and OE groups, and the comparative analysis of regional lymph node showed that there was no significant difference except 2L group (11.1% [5/45] vs. 38.1% [8/21], P = 0.025). The LNM degree of OE group was significantly higher than that of MIE group (27.2% [47/173] vs. 7.6% [32/419], P < 0.001), and the comparative analysis of regional LNM degree showed that there was no significant difference except 2L (34.7% [17/49] vs. 7.7% [13/169], P < 0.001) and 4L (23.8% [5/21] vs. 3.9% [2/51], P= 0.031) subgroups. Conclusion::MIE may have an advantage in LND of upper mediastinum 2L and 4L groups, while it was similar to OE in other stations of LND.

Objective: The current investigation aimed to determine the appropriate dosage form by comparing solid dispersion and liposome to achieve the purpose of improving the solubility and bioavailability of linarin. Methods: Linarin solid dispersion (LSD) and linarin liposome (LL) were developed via the solvent method and the thin film hydration method respectively. The Transwell chamber model of Caco-2 cells was established to evaluate the absorption of drug. The pharmacokinetics of linarin, LSD and LL in rats after ig administration were carried out by high performance liquid chromatography (HPLC) method. Results: The solubility of LSD and LL was severally 3.29 times and 3.09 times than that of linarin. The permeation coefficients of LSD and LL were greater than 10

Objective:To study the association between histopathological features and HER2 overexpression/amplification in breast cancers using deep learning algorithms.Methods:A total of 345 HE-stained slides of breast cancer from 2012 to 2018 were collected at the China-Japan Friendship Hospital, Beijing, China. All samples had accurate diagnosis results of HER2 which were classified into one of the 4 HER2 expression levels (0, 1+, 2+, 3+). After digitalization, 204 slides were used for weakly supervised model training, and 141 used for model testing. In the training process, the regions of interest were extracted through cancer detected model and then input to the weakly supervised classification model to tune the model parameters. In the testing phase, we compared performance of the single- and double-threshold strategies to assess the role of the double-threshold strategy in clinical practice.Results:Under the single-threshold strategy, the deep learning model had a sensitivity of 81.6% and a specificity of 42.1%, with the AUC of 0.67 [95% confidence intervals (0.560,0.778)]. Using the double-threshold strategy, the model achieved a sensitivity of 96.3% and a specificity of 89.5%.Conclusions:Using HE-stained histopathological slides alone, the deep learning technology could predict the HER2 status using breast cancer slides, with a satisfactory accuracy. Based on the double-threshold strategy, a large number of samples could be screened with high sensitivity and specificity.

Objective To observe the dynamic changes of TNF-α,IL-1β,IL-6,IL-10,and expressions of Notch-1,NF-κB mRNA and their protein levels in the brain tissue of septic mice and intervention effects of intrathecal injection of lentiviral vector of miR-34a gene for regulating Notch-1/NF-κB signaling pathway.Methods A total of 54 mice of clean grade were divided randomly (random number) into four groups,namely sham group (n =9),in which sham-operated laparotomy was performed;CLP group (n=15),in which the cecum ligation operation (CLP) was performed;NC group (n =15),in which intrathecal injection of lentivirus 5 μL (concentration 5 × 108 TU/mL),one time per day,for 3 days,then CLP was performed on the seventh day;intervention group (n =15),in wihch intrathecal injection of miR-34a lentivirus 5 μL (concentration 5 × 108 TU/mL),one time per day,for 3 days,then CLP was performed on the seventh day.The mice of four groups were sacrificed 24 h after modeling or operation.The changes of behavior of mice was observed and the neurological scores were assessed 24 h after CLP.The levels of TNF-α,IL-1β,IL-6 and IL-10 in the brain were measured by ELISA method.The mRNA expression and protein levels of Notch-1 and NF-κB in the brain tissue were measured by real-time PCR and Western blot method,respectively.Pathological changes of brain tissue were observed under light microscope.Results The neurological scores,the cerebral TNF-α,IL-6 levels,the mRNA expression and protein level of NF-κB (P＜0.01),and IL-1β levels (P ＜0.05) in CLP group 24 h after modeling were higher than those in sham group.The cerebral IL-10 level and the mRNA expression and protein level of Notch-1 (P ＜ 0.01) in CLP group 24 h after modeling were lower than those in sham group.The neurological scores,the cerebral TNF-α and IL-1β levels,and the protein level of NF-κB (P ＜0.01),and IL-6 (P ＜ 0.05) in NC group 24 h after modeling were higher than those in sham group.The cerebral IL-10 level,the mRNA expression and protein level of Notch1 in NC group 24 h after modeling were lower than those in sham group.There were no significant difference in neurological socres,IL-1β and IL-6 levels between intervention group and CLP group (P ＞ 0.05).The IL-10 level (P ＜ 0.05) and the mRNA expression (P ＜ 0.05) and protein level (P ＜ 0.01) of Notch-1 in intervention group 24 h after modeling were lower than those in CLP group.There were no significant difference in biomarkers between NC group and CLP group (P ＞ 0.05).The degree of cerebral damage found under light microscope was also ameliorated in intervention group compared with CLP group 24 h after modeling.Conclusions The effects of miR-34a via regulating Notch-1/NF-κB signaling pathway on brain function exerts cerebral protective effects in septic mice.