ObjectiveThis research focused on examining the distinctive characteristics of nutrient intake and dietary patterns among long-lived elderly individuals. Additionally， the study was aimed to explore the specific dietary components that may impact the skeletal muscle mass in this particular group. MethodsThis study was conducted in the Chongming area of Shanghai， China. A total of 206 long-lived elderly individuals aged 90 or above were recruited. The 3-day 24-hour dietary recall method was used to collect dietary information and general demographic data through face-to-face interviews with professional nutritionists. The skeletal muscle mass index（SMI） was measured by bioelectrical impedance analysis（BIA）， and low skeletal muscle mass was diagnosed based on the 2019 Asian Working Group for Sarcopenia criteria. T-test analysis， chi-square test， and logistic regression were used to analyze the relationship between dietary nutrient intake and skeletal muscle mass. ResultsIn terms of food intake categories， compared with the long-lived elderly people with normal muscle mass， the intake of cereals containing miscellaneous beans and vegetables in the long-lived elderly people with low muscle mass was significantly lower（P<0.05）. In terms of the nutrient intake， compared with the long-lived elderly people with normal muscle mass， the intake of total energy， carbohydrate， dietary fiber， vitamin D， folic acid， phosphorus， potassium， magnesium， iron， and manganese in the long-lived elderly people with low muscle mass was significantly lower（P<0.05）. After continuous adjustment for the covariates， multivariate logistic regression analysis found that the intake levels of folic acid and dietary fiber were important factors influencing skeletal muscle mass， Individuals with lower intake levels of folic acid and dietary fiber are at a higher risk of low muscle mass in long-lived elderly individuals ［OR_{folic acid T1}， _{dietary fiber T1} （95%CI）： 2.90 （1.11‒7.61）； 4.09 （1.53‒10.91）］. ConclusionThe consumption of cereals that include a variety of beans and vegetables was noticeably lower in the long-lived elderly individuals with lower muscle mass when compared to those with normal muscle mass. Furthermore， low levels of folic acid and dietary fiber intake are associated with an increased risk of low skeletal muscle mass.

Mucinous ovarian cancer(MOC)is a rare pathological type different from epithelial ovarian cancer,and the clinical treatment should refer to serous ovarian cancer(SOC)guidelines.However,since the clinicopathological features of MOC are significantly different from SOC,careful differentiation is needed in diagnosis and treatment.Surgery combined with adjuvant chemotherapy is the standard treatment for MOC.However,due to the low prevalence rate,it is difficult to carry out clinical trials,hence lacking evidence-based medicine and consensus on the indications of intraoperative appendectomy and the choice of postoperative adjuvant chemotherapy.In addition,further translational preclinical studies of targeted therapy and immunotherapy are needed to facilitate the diagnosis and individualized treatment of MOC.

Objective:To investigate the anxiety and depression of elderly patients with lung cancer before and after chemotherapy.Methods:A total of 168 elderly patients diagnosed with lung cancer and eligible for chemotherapy in a Grade A tertiary hospital in Shenyang from Jan 2022 to Feb 2024 were selected as the study subjects.The basic data,self-rating depression scale(SDS),and self-rating anxiety scale(SAS)scores before and after chemotherapy were collected.The Spearman rank correlation test was used to analyze the correlation of the general data of patients with SDS and SAS scores before and after chemotherapy.Results:SDS and SAS scores of lung patients after chemotherapy were significantly higher than those before chemotherapy(P＜0.05).The proportion of patients with depression and anxiety after chemotherapy was also significantly higher than that before chemotherapy(P＜0.05).Results of Spearman's rank correlation test showed that,the increase of SDS and SAS scores was correlated with gender,pathological type,chemotherapy cycle,combined underlying diseases,and respiratory symptoms(P＜0.05).Conclusions:Chemotherapy increases the proportion of anxiety and depression in elderly patients with lung cancer.Gender,pathological type,chemotherapy cycle,combined underlying diseases,and respiratory system symptoms are correlated with the occurrence of anxiety and depression.

BACKGROUND: Perioperative treatment has become an increasingly important aspect of the management of patients with non-small cell lung cancer (NSCLC). Small-scale clinical studies performed in recent years have shown improvements in the major pathological remission rate after neoadjuvant therapy, suggesting that it will soon become an important part of NSCLC treatment. Nevertheless, neoadjuvant immunotherapy may be accompanied by serious adverse reactions that lead to delay or cancelation of surgery, additional illness, and even death, and have therefore attracted much attention. The purpose of the clinical recommendations is to form a diagnosis and treatment plan suitable for the current domestic medical situation for the immune-related adverse event (irAE). METHODS: This recommendation is composed of experts in thoracic surgery, oncologists, thoracic medicine and irAE related departments (gastroenterology, respirology, cardiology, infectious medicine, hematology, endocrinology, rheumatology, neurology, dermatology, emergency section) to jointly complete the formulation. Experts make full reference to the irAE guidelines, large-scale clinical research data published by thoracic surgery, and the clinical experience of domestic doctors and publicly published cases, and repeated discussions in multiple disciplines to form this recommendation for perioperative irAE. RESULTS: This clinical recommendation covers the whole process of prevention, evaluation, examination, treatment and monitoring related to irAE, so as to guide the clinical work comprehensively and effectively. CONCLUSIONS Perioperative irAE management is an important part of immune perioperative treatment of lung cancer. With the continuous development of immune perioperative treatment, more research is needed in the future to optimize the diagnosis and treatment of perioperative irAE.

Objective:To observe the effect of goal-oriented management of continuous monitoring of regional cerebral oxygen saturation (rSO 2) on early postoperative neurocognitive disorders (PND) in elderly spinal surgery patients. Methods:From November 2018 to July 2019, 60 patients undergoing posterior lumbar interbody fusion in the Second Hospital of Shanxi Medical University were selected and randomly divided into control group and intervention group, 30 cases in each group. RSO 2 was recorded before anesthesia induction (T 0), 10 min after anesthesia induction (T 1), 10 min after prone position (T 2), 10 min after spinal decompression (T 3), 30 min after spinal decompression (T 4) and 10 min after extubation (T 5); The basic value of rSO 2, the minimum value of rSO 2 (rSO 2min), the average value of rSO 2 (rSO 2mean) and the maximum percentage of decrease of rSO 2 (rSO 2% max) were recorded. When rSO 2 <55% or rSO 2% max >10% and the duration was longer than 15 s, the intervention group took measures such as adjusting head position, adjusting blood pressure, increasing FiO 2 and respiratory parameters, increasing P ETCO 2 until rSO 2 returned to the required range; The control group did not interfere with the intraoperative rSO 2. Neuropsychological tests were used to evaluate the cognitive function of the two groups 7 days after operation. The patients were followed up 30 days after operation with the revised cognitive function telephone questionnaire (TICS-M). The incidence of postoperative neurocognitive impairment (PND) was recorded. The perioperative data and postoperative adverse reactions of the two groups were recorded. Results:At T 3 and T 4, the rSO 2 of the intervention group was significantly higher than that of the control group ( P<0.01), the intraoperative rSO 2min and rSO 2mean of the intervention group were higher than the control group, and the rSO 2%max was lower than the control group ( P<0.05). The incidence of PND 7 days after surgery, extubation time, postanesthesia care unit (PACU) stay time, hospital stay and postoperative adverse reactions in the intervention group were lower than those in the control group ( P<0.05). There was no significant difference in the incidence of PND 30 days after operation between the two groups ( P>0.05). Conclusions:The goal-oriented management of rSO 2 can reduce the incidence of early postoperative PND in elderly spine surgery patients, which is conducive to the rapid recovery of patients after surgery.

BACKGROUND: To date, there is no effective treatment for thromboangiitis obliterans (TAO). Anlotinib, as a third-line therapy, is recommended for patients with refractory advanced non-small cell lung cancer (NSCLC). We presented a case report of a patient suffering from right lung squamous cell carcinoma combined with thromboangiitis obliterans, and analyzed the treatment dilemma, which provided a new idea for the treatment of these two diseases. METHODS: A patient of right lung squamous cell carcinoma complicated with TAO was admitted to the department of respiratory and critical care medicine of the Shanghai General Hospital in August 2018. The diagnosis and treatment was retrospectively analyzed, and the literature was reviewed. RESULTS: The 73-year-old male patient complained of cough and sputum for 5 months and was diagnosed with NSCLC (T4N2M0, stage IIIb, performance status score 2) in right upper lung by tracheoscopy biopsy. Pigmentation in both lower extremities accompanied by weakened pulse of dorsal foot artery was confirmed. He had a history of smoking, and suspected vascular intermittent claudication and wandering phlebitis for more than one year. Ultrasound indicated multiple arterial occlusion in both upper and lower extremities and deep venous thrombosis in lower extremities. TAO was diagnosed. Peripherally inserted central catheter (PICC) implantation and intravenous infusion post implantation failed and he could not receive chemotherapy. Vascular endothelial growth factor (VEGF) signal pathway dysfunction is also involved in TAO. Anlotinib (12 mg qd po) was selected for treatment NSCLC and TAO, accordingly. He had partial response (PR) and the cancer kept stable for 14 months. At the same time, TAO improved. CONCLUSIONS Anlotinib effectively controlled the growth of NSCLC and improved TAO related symptoms. Anlotinib maybe normalize disordered growth of blood vessels through the VEGF signaling pathway, rather than simply inhibiting angiogenesis.

Objective: To explore the value of GALAD model, including gender, age, AFP, AFP-L3 and DCP in diagnosis of primary hepatocellular carcinoma and prediction of microvascular invasion (MVI). Methods: Using retrospective study method, 5 919 patients with primary hepatocellular carcinoma (HCC) who received radical operation from January 2015 to December 2018 in Eastern Hepatobiliary Surgery Hospital were enrolled into study group. At the same time, 1 745 patients with benign liver diseases (BLDs) were enrolled into control group. The concentration of DCP was detected by Lumipulse G1200 automatic immune analyzer, and the concentration of AFP was detected by Cobas e601 automatic immune analyzer. AFP-L3 was detected by affinity adsorption centrifugation. The non-parametric Mann Whitney test was used to compare the difference between two groups. The chi square test was used to compare the rates. The diagnostic value of single serological marker and GALAD model for primary hepatocellular carcinoma was analyzed. The predictive effect of GALAD model on MVI of primary hepatocellular carcinoma was evaluated. Results: Compared with single serum marker, the diagnostic value of GALAD model is higher. When the cutoff value is -0.33, the diagnostic sensitivity, specificity and accuracy reach to 91.9% (5 440/5 919), 86.8% (1 515/1 745) and 90.7% (6 955/7 664), respectively. The area under the curve can reach 0.960 [95%CI (0.955-0.964)]. Compared with no MVI (M_O) group, the value of GALAD model in MVI low-risk group (M₁), MVI high-risk group (M₂) and MVI (M₁₊₂) were significantly higher (Z values were-12.517, -22.883, -21.655, P<0.05), Galad model predicts MVI (M2) in high risk group,AUC was 0.717 [95%CI (0.701-0.733)] (M₀ ratio M₂). Conclusion GALAD model has better diagnostic performance in primary hepatocellular carcinoma and has certain predictive value for microvascular invasion.

Objective: To analyze the mental health status and its impact factors among nurses, finding ways to improve the mental health of nurses. Methods: A total of 13 425 female healthcare workers aged from 18 to 65 were selected as study objects. The survey was conducted with unified design questionnaire. The survey included the basic situation of the individuals and SCL-90 questionnaire. Comparing the female doctors, the mental health status and its impact factors of nurses were analyzed. Results: The income, age, education and occupation, which include shift work, heavy work load and overtime work are different between nurses and doctors. The main mental health problems of nurses were obsessive-compulsive symptoms, depressive symptoms and somatization. The results of univariate analysis indicated that shift work, overtime work, and heavy work load affected the positive rate of each factor. The results of multivariate analysis showed that occupation, shift work, overtime work, and heavy work load have significant adverse effects on the positive rate of the total score in female healthcare workers (P<0.01) . The positive rate of each dimension of SCL-90 in nurses is significantly higher than that of doctors. Conclusion The mental health problems of nurses are significantly higher than doctors. The main reasons are low occupational level and adverse workstyles which include shift work, heavy workload and so on. Health administration and hospital management departments should pay much more attention to the mental health of nurses, improving their mental health through a variety of ways.

At present, long-acting interferon combined with ribavirin is still a major therapeutic method for hepatitis C in China, and precision medicine can help cure more patients with hepatitis C. This article briefly introduces the diagnosis and treatment of hepatitis in China and the importance of the strategy of virologic response-guided therapy (RGT), and analyzes the influencing factors for the achievement of sustained virologic response. HCV RNA quantitation is the foundation of RGT strategy, and HCV RNA quantitation with a high specificity performed at crucial time points during treatment helps to evaluate response accurately, realize the individualized treatment of hepatitis C, and improve the cure rate of hepatitis C.

Objective To investigate different dosage of dexmedetomidine for preventing elderly postanes-thetic shivering.Methods 100 ASAⅠ~Ⅱ elderly patients (60~80 ages)scheduled for laparotomy were enrolled in this study.According to a computer-generated list of random numbers,patients were randomly allocated to receive dexmedetomidine in the four groups:group A (0.9%normal saline),group B (dexmedetomidine 0.25μg/kg),group C (dexmedetomidine 0.5μg/kg),group D (dexmedetomidine 0.75μg/kg).The occurrence of postanesthetic shive-ring and adverse reactions in perioperative period and post operation were observed.Results The incidence rate shiv-ering were 24% and 20% in group C and D,which were significantly lower than 64% in group A (χ2 =5.333,6. 876,all P<0.05),but there was no difference between C and D groups(χ2 =0.117,P>0.05).Rectal temperature was no difference among four groups(F=1.271,P>0.05).Extubation time was shorter in group A(21.6 ±4.0)min than that in group D(24.4 ±2.8)min(F=6.194,P<0.05).Conclusion Our results suggest that dexmedetomi-dine 0.5 or 0.75 μg/kg can prevent shivering after general anesthesia effectively.But potential for delayed extubation time with dexmedetomidine was noted.The loading dose of 0.5 μg/kg dexmedetomidine is recommeded to prevent eld-erly shivering after general anesthesia.