Background: and Purpose Vertebrobasilar fusiform aneurysms (VBFAs) carry substantial morbidity and mortality, but optimal management for unruptured VBFAs remains unclear. We compared the safety and efficacy of conservative management (CM), stent-assisted coiling (SAC), and flow diverters (FDs) in patients with unruptured VBFAs, focusing on long-term prognosis. Methods: This study included data from a nationwide Chinese cohort of patients with vertebrobasilar dissecting aneurysms. Inverse probability of treatment weighting (IPTW) balanced confounders across groups. The primary outcome was poor prognosis (modified Rankin Scale score >2). Secondary outcomes included aneurysm rupture, ischemic stroke, compression symptoms, and VBFA-related deaths. Logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs). Subgroup and sensitivity analyses were performed. Results: Among 1,115 patients with unruptured VBFAs, 838 (median age, 54 years; 655 men) were included. After IPTW, baseline characteristics were balanced. Median follow-up was 54 months. FD was associated with a lower risk of poor prognosis than CM (OR, 0.48 [95% CI, 0.30 to 0.77]; p=0.002), with no difference between CM and SAC. FD also reduced aneurysm rupture (OR, 0.20 [95% CI, 0.07 to 0.60]; p=0.004) and compression symptoms (OR, 0.30 [95% CI, 0.13 to 0.68]; p=0.004) versus CM. Time-to-event analyses further revealed significant differences in vertebral artery lesions and Type I–II VBFAs, whereas no significant differences were observed in basilar or vertebrobasilar junction lesions or in Type III–IV VBFAs. Conclusions Compared with CM, FD was associated with improved long-term outcomes in unruptured VBFAs, particularly in vertebral artery lesions and Type I–II VBFAs, although residual confounding cannot be excluded.

OBJECTIVE To explore the influencing factors of Shenfukang capsule in the treatment of chronic kidney disease （CKD） and construct a nomogram prediction model for evaluating its therapeutic efficacy. METHODS CKD patients who were hospitalized from July 2019 to August 2022 in the First Affiliated Hospital of Guangxi Medical University and treated with Shenfukang capsule were selected as study subjects. Clinical data of the patients were collected from the hospital’s electronic medical record system， and they were divided into an effective group and an ineffective group based on treatment outcomes. Lasso-Logistic multivariate regression analysis was used to screen the influencing factors of the efficacy of Shenfukang capsule. Using the effectiveness of Shenfukang capsule treatment as the prediction outcome and the screened influencing factors as predictor variables， a nomogram prediction model was constructed using R software. All patients were randomly divided into a training cohort and a validation cohort. The discriminative ability， calibration， and clinical net benefit of the model were evaluated using the receiver operating characteristic （ROC） curve， calibration curve， and decision curve analysis， respectively. RESULTS Lasso-Logistic regression analysis revealed that concurrent diabetes mellitus， decreased levels of blood urea nitrogen， triglycerides， and serum phosphorus， as well as prolonged prothrombin time and elevated apolipoprotein AⅠ levels， were influencing factors for reduced efficacy of Shenfukang capsule in CKD treatment. The evaluation results of the nomogram prediction model showed that the area under curve values were 0.745 and 0.797 in the training and validation cohorts， respectively， which were close and both exceeded 0.70， indicating stable predictive performance. The calibration curves demonstrated good agreement in both datasets， suggesting satisfactory calibration performance. The clinical decision curves were positioned above the two extreme reference lines， indicating high clinical benefit of the model. CONCLUSIONS Diabetes mellitus， blood urea nitrogen， triglycerides， apolipoprotein AⅠ， serum phosphorus， and prothrombin time were factors associated with the efficacy of Shenfukang capsule in CKD patients. The nomogram prediction model established in this study may provide a basis for rational clinical application of Shenfukang capsule and for improving its therapeutic efficacy in CKD.

OBJECTIVE To explore the influencing factors of Shenfukang capsule in the treatment of chronic kidney disease （CKD） and construct a nomogram prediction model for evaluating its therapeutic efficacy. METHODS CKD patients who were hospitalized from July 2019 to August 2022 in the First Affiliated Hospital of Guangxi Medical University and treated with Shenfukang capsule were selected as study subjects. Clinical data of the patients were collected from the hospital’s electronic medical record system， and they were divided into an effective group and an ineffective group based on treatment outcomes. Lasso-Logistic multivariate regression analysis was used to screen the influencing factors of the efficacy of Shenfukang capsule. Using the effectiveness of Shenfukang capsule treatment as the prediction outcome and the screened influencing factors as predictor variables， a nomogram prediction model was constructed using R software. All patients were randomly divided into a training cohort and a validation cohort. The discriminative ability， calibration， and clinical net benefit of the model were evaluated using the receiver operating characteristic （ROC） curve， calibration curve， and decision curve analysis， respectively. RESULTS Lasso-Logistic regression analysis revealed that concurrent diabetes mellitus， decreased levels of blood urea nitrogen， triglycerides， and serum phosphorus， as well as prolonged prothrombin time and elevated apolipoprotein AⅠ levels， were influencing factors for reduced efficacy of Shenfukang capsule in CKD treatment. The evaluation results of the nomogram prediction model showed that the area under curve values were 0.745 and 0.797 in the training and validation cohorts， respectively， which were close and both exceeded 0.70， indicating stable predictive performance. The calibration curves demonstrated good agreement in both datasets， suggesting satisfactory calibration performance. The clinical decision curves were positioned above the two extreme reference lines， indicating high clinical benefit of the model. CONCLUSIONS Diabetes mellitus， blood urea nitrogen， triglycerides， apolipoprotein AⅠ， serum phosphorus， and prothrombin time were factors associated with the efficacy of Shenfukang capsule in CKD patients. The nomogram prediction model established in this study may provide a basis for rational clinical application of Shenfukang capsule and for improving its therapeutic efficacy in CKD.

Objective To understand the current status of knowledge-attitude-practice(KAP)regarding risk of medication safety behavior among cancer patients in western Yunnan and the related influencing factors,and to provide a basis for conducting rational medication education.Methods Using an approximate random sampling method,a KAP survey on medication safety behavior was conducted among inpatients and outpatients with cancer(aged over 18 years)in multiple hospitals in western Yunnan through online and offline questionnaires.Multiple linear regression analysis was used to explore the impact of different characteristics of the research objects on the KAP scores concerning medication knowledge,behavior,and attitude.Results A total of 512 valid questionnaires were collected.The average scores of medication knowledge,attitude,and behavior among cancer patients were(82.53±23.07),(41.98±8.64),and(67.88±10.08),respectively.Medication knowledge and behavior were at a good level,while medication attitude was at a qualified level.The multiple linear regression results showed that the educational level was a significant influencing factor of the medication knowledge and attitude scores(P＜0.001).Conclusion The overall medication safety among cancer patients in western Yunnan is in a good state,however,there is a need for improvement in medication attitudes.Educational level is the main factor affecting medication safety risk.Pharmacy services should be focused on cancer patients with lower educational levels to enhance their medication safety.

Objective To analyze cysteinylaspartate specific proteinase-3,caspase-7,caspase-9,AMP activated protein kinase(AMPK)in the diagnosis and prognosis evaluation of sepsis.Methods Sixty patients with sepsis from the Affiliated Hospital of Xiangnan University from March 2020 to March 2023 were selected as the observation group,and another 60 healthy individuals from the physical examination center of the hospital during the same period were selected as the control group.Acute physiology and chronic health evaluationⅡ(APACHEII)score was used to evaluate the severity of the patient's condition.Serum caspase-3,caspase-7,caspase-9,AMPK and APACHEII scores were detected,and compared between the two groups.These parameters were compared with serum Caspase-3,caspase-7,caspase-9,AMPK and APACHEII scores in different disease severity groups.The patients were divided into survival group(50 cases)and death group(10 cases)according to prognosis.Serum Caspase-3,caspase-7,caspase-9,AMPK and APACHEII scores were compared between the two groups,and the correlation between serum caspase-3,caspase-7,caspase-9,AMPK and APACHEII scores were analyzed by Pearson.Receiver operating characteristic(ROC)was drawn,the area under the curve(AUC)was calculated,the predictive efficacy of serum caspase-3,caspase-7,caspase-9 and AMPK in patients death with sepsis were analyzed.Results The serum levels of caspase-3,caspase-7,caspase-9,AMPK,and APACHEII score in the observation group were higher than those in the control group,and the differences were statistically significant(t=19.501～44.219,all P<0.05).The serum caspase-3,caspase-7,caspase-9,AMPK,and APACHEII scores in the sep-tic shock group were higher than those in the severe and mild groups,and the differences were statistically significant(t=2.091～6.946,all P<0.05).The serum caspase-3,caspase-7,caspase-9,AMPK,and APACHEII scores of the death group were higher than those of the survival group,and the differences were statistically significant(t=4.576～8.835,all P<0.05).Serum caspase-3,caspase-7,caspase-9 and AMPK were positively correlated with APACHEII scores(r=0.382～0.406,all P<0.05).The AUC of combined detection of serum caspase-3,caspase-7,caspase-9,and AMPK for predicting death in sepsis patients was 0.863,with 95%confidence interval of 0.805-0.958.which was greater than that of single indicator detection,and the difference is statistical-ly significant(Z=2.912～2.294,all P<0.05).Conclusion Serum caspase-3,caspase-7,caspase-9,and AMPK in sepsis patients showed abnormally high expressions,which were closely related to disease severity and prognosis.Combined detection could improve the sensitivity and specificity of death prediction,which has certain reference value.

Objective:To investigate the efficacy of high-flux hemodialysis combined with hemoperfusion in patients with uremia.Methods:Eighty patients with uremia who received treatment at the Quzhou Hospital Affiliated to Wenzhou Medical University (Quzhou People's Hospital) from January 2020 to December 2022 were selected for this prospective randomized controlled trial. Participants were grouped using a random number table method, with 40 patients in the study group receiving high-flux hemodialysis combined with hemoperfusion, and 40 patients in the control group receiving high-flux hemodialysis alone. Toxicity clearance, calcium-phosphate metabolism, immune function, and vascular endothelial function were assessed using competitive enzyme-linked immunosorbent assay, immunofluorescence assay, fully automated biochemical analyzers, and immunoturbidimetric assay. The differences in toxicity clearance, calcium-phosphate metabolism, immune function, and vascular endothelial function were compared between the two groups.Results:Compared with before treatment, both groups showed a significant decrease in parathyroid hormone (PTH), blood creatinine, β 2-microglobulin, blood urea nitrogen, blood phosphorus, advanced glycation end products (AGEs), intercellular adhesion molecule-1 (ICAM-1), and homocysteine (Hcy) after treatment. Specifically, PTH levels decreased from (353.28 ± 50.26) ng/L to (235.26 ± 31.51) ng/L in the control group and from (357.17 ± 52.18) ng/L to (174.16 ± 26.35) ng/L in the study group; blood creatinine decreased from (969.47 ± 110.44) μmol/L to (511.57 ± 91.96) μmol/L in the control group and from (957.58 ± 121.99) μmol/L to (414.37 ± 87.41) μmol/L in the study group; β 2-microglobulin decreased from (40.27 ± 7.98) mg/L to (22.06 ± 3.26) mg/L in the control group and from (41.65 ± 8.40) mg/L to (17.70 ± 3.43) mg/L in the study group; blood urea nitrogen decreased from (30.64 ± 5.63) mmol/L to (14.02 ± 2.80) mmol/L in the control group and from (30.04 ± 5.90) mmol/L to (10.07 ± 1.94) mmol/L in the study group; blood phosphorus decreased from (2.23 ± 0.49) mmol/L to (1.80 ± 0.36) mmol/L in the control group and from (2.26 ± 0.53) mmol/L to (1.53 ± 0.31) mmol/L in the study group ; Hcy decreased from (35.87 ± 5.34) μmol/L to (30.93 ± 4.65) μmol/L in the control group and from (36.21 ± 5.27) μmol/L to (20.26 ± 4.53) μmol/L in the study group; ICAM-1 decreased from (574.96 ± 56.81) ng/L to (419.87 ± 40.76) ng/L in the control group and from (569.84 ± 52.37) ng/L to (384.51 ± 35.12) ng/L in the study group; AGEs levels decreased from (330.41 ± 43.69) mg/L to (297.64 ± 38.59) mg/L in the control group and from (326.98 ± 41.25) mg/L to (165.42 ± 15.74) mg/L in the study group. Conversely, compared with before treatment,blood calcium, immunoglobulin G, immunoglobulin M, immunoglobulin A, CD 4+, CD 4+/CD 8+ ratio, complement 3, and complement 4 all increased after treatment. Specifically, blood calcium increased from (1.90 ± 0.43) mmol/L to (2.27 ± 0.32) mmol/L in the control group and from (1.93 ± 0.46) mmol/L to (2.61 ± 0.36) mmol/L in the study group; IgG increased from (7.73 ± 1.56) g/L to (9.21 ± 2.04) g/L in the control group and from (7.82 ± 1.62) g/L to (10.7 ± 2.02) g/L in the study group; IgM increased from (0.42 ± 0.07) g/L to (1.29 ± 0.11) g/L in the control group and from (0.40 ± 0.08) g/L to (1.52 ± 0.08) g/L in the study group; IgA increased from (0.44 ± 0.16) g/L to (1.54 ± 0.25) g/L in the control group and from (0.48 ± 0.19) g/L to (1.93 ± 0.38) g/L in the study group; CD 4+ increased from (32.77 ± 5.71)% to (38.18 ± 4.92)% in the control group and from (32.11 ± 5.34)% to (46.07 ± 4.95)% in the study group; the CD 4+/CD 8+ ratio increased from (1.07 ± 0.14) to (1.29 ± 0.15) in the control group and from (1.07 ± 0.17) to (1.61 ± 0.26) in the study group; C3 increased from (0.80 ± 0.12) g/L to (1.01 ± 0.20) g/L in the control group and from (0.79 ± 0.14) g/L to (1.19 ± 0.23) g/L in the study group; and C4 increased from (0.32 ± 0.15) g/L to (0.67 ± 0.17) g/L in the control group and from (0.33 ± 0.14) g/L to (0.86 ± 0.12) g/L in the study group. All these differences were statistically significant between the two groups ( t = 12.01, 19.47, 33.98, 33.72, 17.64, 20.36, 22.75, 24.28, 19.25, 22.77, 4.71, 29.54, 32.01, 27.39, -5.06, -11.39, -4.79, -9.65, -61.55, -97.13, -36.63, -32.21, -7.71, -16.90, -5.78, -11.34, -9.21, -13.28, -13.25, -33.73, all P < 0.05). Additionally, when compared with the control group, the study group showed superior results ( t = -9.40, -4.84, -5.82, -7.33, -3.59, -10.40, -4.16, -20.07, 4.47, 3.28, 5.43, 7.14, 6.73, 3.73, 5.76, all P < 0.05). Conclusions:High-flux hemodialysis combined with hemoperfusion for the treatment of uremia can effectively improve calcium and phosphorus metabolism and vascular endothelial function, as well as enhance immune function and toxicity clearance rate.

Objective:To investigate the effects of warm compresses with Jianlou Decoction combined with aspirin enteric coated tablets on the function of autologous arteriovenous fistula (AVF) and hemodynamics in patients with uremia. Methods:A prospective study was conducted involving 90 patients with uremia who underwent AVF creation at Quzhou Hospital Affiliated to Wenzhou Medical University (Quzhou People's Hospital), from January 2018 to December 2023. The patients were randomly divided into a control group (45 patients receiving aspirin enteric coated tablets) and a study group (45 patients receiving warm compresses with Jianlou Decoction combined with aspirin enteric coated tablets). The internal diameter and blood flow of the fistula, vascular endothelial function, hemodynamics, the presence of vascular murmurs, elasticity, fistula patency and function, and the occurrence of complications were compared between the two groups. Results:After 1 month of treatment, the internal diameter of AVF increased in each group [study group: (6.69 ± 1.93) mm vs. (5.02 ± 1.56) mm; control group: (5.69 ± 1.78) mm vs. (4.93 ± 1.30) mm] compared with before treatment ( t = 8.29, 2.63, both P < 0.05). The blood flow of AVF increased in each group [study group: (530.49 ± 91.88) mL/min vs. (236.51 ± 21.84) mL/min; control group: (418.16 ± 53.87) mL/min vs. (242.36 ± 22.33) mL/min] compared with before treatment ( t = 23.85, 28.69, both P < 0.05). After 1 month of treatment, the internal diameter and blood flow of AVF in the study group were greater compared with those in the control group ( t = 2.55, 7.07, both P < 0.05). After 1 month of treatment, the levels of endothelin-1 in each group significantly decreased compared with before treatment [control group: (64.83 ± 11.80) μmol/L vs. (102.48 ± 16.60) μmol/L; study group: (49.48 ± 12.15) μmol/L vs. (104.60 ± 16.52) μmol/L] compared with before treatment ( t = -19.13, -23.51, both P < 0.05). The levels of nitric oxide [control group: (95.65 ± 14.87) ng/L vs. (78.56 ± 13.47) ng/L; study group: (86.36 ± 14.68) ng/L vs. (76.59 ± 13.56) ng/L], vascular diameter [control group: (7.20 ± 0.63) mm vs. (2.53 ± 0.50) mm; study group: (5.42 ± 0.66) mm vs. (2.47 ± 0.55) mm], vascular wall thickness [control group: (0.82 ± 0.05) mm vs. (0.28 ± 0.07) mm; study group: (0.60 ± 0.05) mm vs. (0.29 ± 0.10) mm], and blood flow [control group: (825.00 ± 65.00) mL/min vs. (314.84 ± 72.75) mL/min; study group: (623.71 ± 74.19) mL/min vs. (321.24 ± 71.62) mL/min] in each group significantly increased compared with before treatment ( t = 9.50, 4.99, 48.94, 26.89, 48.33, 22.11, 55.92, 29.50, all P < 0.05). Additionally, after 1 month of treatment, the levels of endothelin-1 in the study group were significantly lower than those in the control group ( t = 6.08, P < 0.05). The levels of nitric oxide, vascular diameter, vascular wall thickness, and blood flow in the study group were greater than those in the control group ( t = 2.98, 13.15, 21.99, 13.69, all P < 0.05). After 1 month of treatment, the shear stress of the radial artery in each group decreased significantly compared with before treatment [control group: (42.96 ± 6.54) dyne/cm2 vs. (47.62 ± 7.36) dyne/cm2; study group: (34.31 ± 6.71) dyne/cm2 vs. (46.71 ± 7.56) dyne/cm2, t = -13.30, -4.67, both P < 0.05]. The blood flow velocity at the venous end of the anastomosis significantly increased in both groups compared with pre-treatment levels [control group: (85.51 ± 8.48) cm/s vs. (74.60 ± 10.80) cm/s; study group: (119.18 ± 10.27) cm/s vs. (73.27 ± 10.37) cm/s, t = 35.92, 10.03, both P < 0.05]. The shear stress of the radial artery in the study group was lower ( t = -6.18, P < 0.05), while the blood flow velocity at the venous end of the anastomosis was higher ( t = 16.95, P < 0.05) compared with the control group. The incidence of vascular murmurs [11.11% (5/45) vs. 28.89% (13/45)] and the failure/reconstruction rate of the fistula [4.44% (2/45) vs. 24.44% (11/45)] were significantly lower compared with the control group ( Z = -2.10, -2.68, both P < 0.05). The rate of good vascular elasticity [93.33% (42/45) vs. 71.11% (32/45)] and the patency rate of the AVF [93.33% (42/45) vs. 73.33% (33/45) in the study group were significantly higher compared with the control group ( Z = 2.74, 2.53, both P < 0.05). The total incidence of complications in the study group was significantly higher than that in the control group [2.22% (1/45) vs. 20.00% (9/45), χ2 = 7.20, P < 0.05). Conclusions:Warm compresses with Jianlou Decoction combined with aspirin enteric coated tablets can increase the internal diameter and blood flow of AVF in patients with uremia, improve endothelial function and hemodynamics, reduce thrombus formation, enhance fistula function and patency rates, and decrease the incidence of fistula failure/reconstruction and complications.

Objective:To sinicize the adolescent personality structure questionnaire(APS-Q), and to examine the psychometric properties of APS-Q among Chinese adolescents.Methods:APS-Q was sinicized and the Chinese version of APS-Q was used for investigation.A sample of 1 207 adolescents were investigated firstly and randomly divided into sample 1 ( n1=590) and sample 2 ( n2=617) for exploratory factor analysis and confirmatory factor analysis, respectively. Moreover, the sample 3 ( n3=420) was collected to conduct confirmatory factor analysis for the second time.Sample 4( n4=83) was used to assess the test-retest reliability of APS-Q. The Chinese big five personality inventory-15 (CBF-PI-15), generalized anxiety disorder-7 (GAD-7) and patient health questionnaire-9 (PHQ-9) were used as criterion tools. Both SPSS 21.0 and Mplus 7.4 software were used for the data analysis. Results:Item analysis showed that the CITCs for items 27, 31 and 35 were low.Exploratory factor analysis suggested that after deleting items 3, 4, 21, 22, 24, 25, 26, 27, 31 and 35, the revised APS-Q was consisted with 25 items, covering 6 dimensions, which were investment and goals, aggression, sense of self, relationship with family, relationship with friends, and self-acceptance, respectively. Confirmatory factor analysis supported the six-factor model fitted well (sample 2: χ2/ df=1.94, RMSEA=0.04, CFI=0.94, TLI=0.93, and SRMR=0.05; sample 3: χ2/ df=2.12, RMSEA=0.05, CFI=0.95, TLI=0.92, and SRMR=0.06). Multigroup CFA indicated that the six-factor structure of APS-Q had strict measurement invariance across sex. The scores of APS-Q were significantly correlated with big five personality, depression, and anxiety(all P<0.05). The total score of APS-Q demonstrated satisfactory internal consistency (α=0.90, ω=0.90, split-half reliability=0.82, MIC=0.27) and test-retest reliability ( r=0.84), while the subscale scores of APS-Q showed acceptable internal consistencies (α=0.71-0.82, ω=0.72-0.82, split-half reliabilities=0.60-0.79, MIC=0.36-0.52) and test-retest coefficients ( r=0.66-0.77). Conclusion:The Chinese version of APS-Q can be used as a reliable and valid measurement to assess personality function for Chinese adolescents.

Objective This study aims to construct and evaluate a clinical decision support system for individualized frequency repositioning in ICU patients using big data and modern information technology,with the goal of improving ICU nursing quality.Methods From February to August 2023,a dedicated research team was established to construct a data model based on real-world data from 3,988 ICU patients,assessing the impact of different position change frequencies on the incidence of pressure injuries.Based on this model,a decision support system was designed and developed,incorporating modules for personalized patient characteristics input,data analysis and result queries,decision recording,and patient file management.From September to November 2023,ICU nurses at a tertiary hospital in Qingdao city was selected to use the system.A usability survey was conducted using the System Usability Scale(SUS)to evaluate the system's usability.Results The constructed decision support system can display the outcomes for patients under 7 different position change frequencies based on the input of personalized patient characteristics and the calculation results from the data model,providing precise decision support for nurses.A total of 85 nurses participated in the system usability evaluation,with the SUS score of 64.22±13.9.Conclusion The constructed individualized frequency of repositioning decision support system for ICU patients demonstrates good scientific validity and usability,providing clinical nurses with a valuable reference for implementing personalized position change frequencies for patients.

Objective To analyze the current status of serum calcium,phosphorus,and hemoglobin(Hb)levels in maintenance hemodialysis patients and identify related influencing factors.Methods Clinical data and related laboratory tests of maintenance hemodialysis patients were retrospective analyzed,clinical related indicators and target achievement rates among different serum calcium,phosphorus and Hb patients were analyzed,correlation and multiple linear regression analysis of serum corrected calcium,phosphorus and Hb and clinical indicators were performed.Results 217 maintenance hemodialysis patients,115(53.0％)cases were male,mean age was(55.88±13.54)years.The target achievement rates for serum corrected calcium,phosphorus,and Hb was 50.70％,24.00％,and 34.10％respectively.Multivariate linear regression analysis revealed that in maintenance hemodialysis patients,serum corrected calcium was independently positively correlated with bicarbonate and Hb;Serum phosphorus was independently positively correlated with creatinine,urea,and serum potassium,but negatively correlated with age;And Hb was independently positively correlated with total protein and serum corrected calcium,while being negatively correlated with C-reactive protein,β2 microglobulin,and parathyroid hormone.Conclusion The control target achievement rates for serum calcium,phosphorus,and Hb in maintenance hemodialysis patients at our center are low.Attention which should be paid to the related influencing factors of these indicators is beneficial to guide the control of complications and provide a reference for clinical disease management.