【Objective】 To explore the correlation between abnormal thalamic functional connectivity (FC) and memory loss in maintenance hemodialysis patients with end-stage renal disease (ESRD). 【Methods】 An auditory verbal learning test (AVLT-H) was conducted on 22 patients with ESRD and 28 age-, sex-, and education-matched healthy controls (HC) to evaluate memory function. After that, resting-state functional magnetic resonance imaging (rs-fMRI) data were gathered, and a whole-brain FC analysis centered on the thalamus was executed to discern variations in thalamic FC between the two groups. Finally, Pearson and Spearman correlation analyses were carried out. 【Results】 Compared to the HC group, the ESRD group exhibited notably lower scores in IR-S (P=0.002), SR-S (P<0.001), and LR-S (P=0.005). Concurrently, the ESRD group demonstrated diminished FC of the right thalamus with the left superior frontal gyrus, the left parietal lobule, the right suproccipital gyrus, the right anterior cuneus, and the right middle frontal gyrus (P<0.05, TFCE correction). Additionally, reduced FC were observed between the left thalamus and the left gyrus rectus, the left parietal lobule, and the right parietal lobule in the ESRD group (P<0.05, TFCE correction). Moreover, the FC values between the left thalamus and the left gyrus rectus in the ESRD group displayed significant negative correlations with IR-S (r=-0.499), SR-S (r=-0.458), and LR-S (r=-0.455) (all P<0.05). 【Conclusion】 Memory impairment is evident in ESRD patients undergoing maintenance hemodialysis, and it appears to be intricately linked to anomalous FC within the left thalamus and the left gyrus rectus. These findings offer potential imaging markers for monitoring memory dysfunction in individuals with ESRD.

Objective:To investigate the dosimetric effects of complex cardiac-respiratory motion in cardiac stereotactic body radiotherapy (CSBRT).Methods:A cardiac motion phantom was employed to simulate patient-specific cardiac-respiratory motion in 10 cases. The measured doses obtained under the phantom motion state were compared with the calculated doses in radiotherapy treatment planning for clinical patients. Moreover, 18 groups of design-based cardiac-respiratory motion were simulated. The radiation doses under the phantom motion state were measured using radiochromic films and compared with those under the resting state.Results:In the patient-specific cardiac-respiratory motion group, the gamma passing rate (GPR) under the 3%/2 mm standard between the measured and the calculated doses was 90.0% ± 7.0%. The correlation coefficient of the respiratory motion amplitude in the superior-inferior (SI) dimension with the GPR was -0.86 ( P=0.01). In the design-based cardiac-respiratory motion groups, the increase in the amplitude of cardiac-respiratory motion reduced the consistency between the dynamic dose and the static reference dose. Especially, the increase in the respiratory motion amplitude produced the most pronounced effect, reducing the width of the 90% isodose line in the respiratory motion direction, with a mean slope of -1.6. Additionally, the increase in the penumbra corresponds to a mean slope of 1.4. Conclusions:The respiratory motion amplitude serves as a primary factor influencing the dose accuracy of CBSRT. The characteristics and dosimetric effects of cardiac-respiratory motion are patient-specific, thus necessitating the assessment of cardiac-respiratory motion characteristics before CBSRT to individualize the application of motion management techniques for enhanced treatment accuracy.

Tirzepatide,the first and currently the only approved GIP/GLP-1 receptor agonist worldwide,has demonstrated favorable effects in glycemic control and body weight reduction in several studies.In recent years,the effects of Tirzepatide on improving cardiovascular risk factors have gained increasing attentions.This article reviews the research progress of the effects of Tirzepatide on the cardiovascular system.

Objective:To investigate the effect of intravenous anesthesia on the detection rate of lesions in diagnostic gastroscopy.Methods:A total of 9 071 subjects who underwent diagnostic gastroscopy at the Digestive Endoscopy Center of Yangzhou University Affiliated Hospital from March 2021 to February 2022 were selected. Data were collected from the gastroscopy quality control system, including age, gender, examination physician, Helicobacter pylori infection, examination method, withdrawal time, number of images left, number of biopsies, biopsy site, gastroscopy diagnosis, pathological diagnosis, etc. They were divided into anesthesia group and general group based on the examination method, and propensity score matching (PSM) was performed on the two groups of subjects. Excluding confounding factors, the detection of lesion location and lesion type in two groups of subjects was analyzed; Simultaneously, univariate and multivariate logistic regression analysis was used to analyze the influencing factors of the detection rate of precancerous lesions and malignant tumors in the upper gastrointestinal tract.Results:After PSM, 1 655 subjects were included in both groups. In terms of lesion location, the detection rate of gastric body lesions in the anesthesia group was higher than that in the general group ( P<0.05), and the detection rate of esophageal lesions in the anesthesia group was lower than that in the general group ( P<0.05); In terms of lesion types, the detection rate of precancerous lesions such as gastric polyps, mucosal protrusions, mucosal atrophy, and intestinal metaplasia in the anesthesia group was higher than that in the general group (all P<0.05). The results of logistic regression analysis showed that intravenous anesthesia was an independent influencing factor for the detection rate of precancerous lesions and malignant tumors in diagnostic gastroscopy ( OR=1.338, 95% CI: 1.070-1.674, P<0.05). Conclusions:Intravenous anesthesia is an independent influencing factor for the detection rate of precancerous lesions and malignant tumors in diagnostic gastroscopy, and can improve the detection rate of upper gastrointestinal lesions.

Purpose: Our study aimed to make a propensity score matching (PSM) analysis on the clinical application of gastricjejunum pouch anastomosis (GJPA) and Billroth-II anastomosis after distal gastrectomy. Methods: We collected clinical data from 249 patients who received distal gastrectomy from January 2016 to July 2020. According to the reconstruction method used, all patients were divided into the Billroth-II group and the GJPA group. Clinical data and operation complications were analyzed. Results: The clinical characteristics of the 2 groups were comparable after PSM. In the Billroth-II group, the incidence rate of delayed gastric emptying was higher than that in the GJPA group. Fewer patients suffered reflux gastritis in the GJPA group. The RGB (residue, gastritis, and bile) scores related to the severity of bile reflux into the remnant stomach, gastritis, and residue were higher in the Billroth-II group. Postoperative nutritional status and Visick classification demonstrated that postoperative subjective feelings in the GJPA group were improved significantly. Conclusion The application of GJPA in reconstruction after distal gastrectomy is safe, economical, and reliable. This reconstruction improved the quality of life of patients. It is worth popularizing widely in clinical settings.

Objective To explore and understand limitations and needs of support for conducting clinical research among clinicians in China.Methods The in-service clinician in our hospital were enrolled in as survey participants,survey questionnaires were designed and filled up by target audience in the questionnaire star platform.Results Main problems identified as restrictions for conducting clinical studies including lack of data platform,have ideas but not protocols,lack of research funding and project management.On the other hand,identified needs for support including research-related technical support,project management facilitation,training,external communication and exchange,as well as quality risk management.Conclusions Hospital should establish Clinical Research Unit to help clinicians to improve research quality by training,providing technical support and administrative service of clinical research.

Objective:To evaluate the status of nursing workplace violence experience and work performance, and analyze the mediating effects of workplace mindfulness between nurses' performance and workplace violence experience.Methods:The convenience sampling method was used. From March to May 2016, the Workplace Violence Questionnaire, Job Performance Scale, and Workplace Mindfulness Scale were used to investigate workplace violence, work performance, and workplace mindfulness encountered by 776 nurses in eight provinces of China. Correlation analysis and mediation effect analysis methods are used to analyze the relationship between the three, and the mediating effects of workplace mindfulness.Results:A total of 776 questionnaires were collected and 696 valid questionnaires. The Workplace Violence Questionnaire Score of 696 nurses was (1.21±0.78) , the score of Workplace Mindfulness Scale was (4.74±0.63) , and the score of Job Performance Scale was (3.77±0.96) . Pearson correlation analysis showed that nurses' work performance was positively correlated with workplace mindfulness ( r=0.235, P<0.01) ; nursing workplace violence was associated with work performance ( r=-0.098, P<0.05) , and workplace mindfulness ( r=-0.217, P<0.01) was negatively correlated with nursing workplace violence. The total effect of workplace violence on job performance was (β=-0.130 6, P<0.01) . Workplace mindfulness played a mediating role between the two, and the mediating effect was -0.067 5. Conclusions:Violence experienced by patients and their families in the workplace can undermine nurses' professional immersion, alertness, and organizational acceptance levels, thereby restricting the performance of nursing work. Increasing the training of nurses in the prevention of violence and interventions in response to violence are of great significance.

Objective To summarize the practical experiences of Clinical Research Unit (CRU) platform established by Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine,provide reference for domestic institutions that have prepared or to prepare to establish CRU platform.Methods Oriented by demand,this platform has set up six modules including project management module,methodology support module,data management module,quality risk management module,project transformation module and training and international exchange module.Besides,it also establishes and improves the corresponding module system,quality assurance,technical support and information data platform system.Results With this platform,the enthusiasm of departments to carry out clinical research has been continuously enhanced,the talent pool of clinical research has been expanded;the awareness of clinical research cooperation has been improved and the international cooperation fields have been further extended;the number of clinical research projects and funding have increased rapidly.Conclusions CRU Platform in Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine provides all-dimensional technical support and whole-process informatization management to improve clinical research quality and efficiency.While learning from the advanced international concepts,we still need to explore and improve the platform construction and management mode in line with general research-oriented hospitals in China,further to enhance the academic research internationally.

Objective: To explore the effects and mechanism of humble leadership on organizational trust and voice behavior of nursing staff. Methods: A total of 249 questionnaires were collected with a questionnaire survey, the effective response rate was 91.54%. The structural equation model was used to test the relationship between variables. Results: The humble leadership had a significantly positive influence on the organizational trust (β= 0.46, P<0.01) and voice behavior (β= 0.63, P<0.01) of nursing staffs, organizational trust played the partial mediating effect (β= 0.29, P<0.01). Conclusion A nursing manager who is good at humble behavior can promote organizational trust among the subordinate nursing team, which in turn, directly and indirectly enhances their positive voice behavior.

Objective To study the expressions of Nodal in normal gallbladder,and gallbladders with cholelithiasis,cholecystitis and carcinoma;and to study the impact of inhibiting or promoting Nodal expressions in gallbladder carcinoma on the Smad2/4 pathway and epithelial-mesenchymal transition.Methods Immunohistochemistry was used to detect the expressions and distributions of Nodal protein in 30 normal gallbladders,96 simple cholecystitis/calculous cholecystitis specimens and 42 gallbladder carcinoma specimens.The mRNA and protein expressions of Nodal in normal and malignant gallbladdcr mucosal epithelium cells and breast cancer cells were detected by RT-PCR,western blotting and wound healing tests.The impact of activating agents and inhibitors on the expression levels of Nodal and its signaling pathway Smad2/4 and EMT-related proteins were analyzed.Results Immunohistochemistry showed that the positive rates of Nodal in the gallbladder cancer group was significantly higher than that in the gallbladder stone group and the normal gallbladder group.The results were 83.3％ (35/42),44.8％ (43/96),6.7％ (2/30) respectively (P＜ 0.01).RT-PCR and Western blotting showed the expressions of Nodal in gallbladder carcinoma cells were higher than normal gallbladder cells (P＜0.05).After using rhNodal to up regulate the Nodal expression,the Smad2 protein phosphorylation was promoted and the EMT associated proteins were up-regulated.After using the inhibitor SB431542 to suppress the Nodal expression,the Smad2 protein phosphorylation decreased and the EMT associated proteins were down-regulated.Conclusions The expression of Nodal was closely related to cell proliferation and metastasis in gallbladder carcinoma.Tumor progression was promoted via the smad2/4 pathway through epithelial-mesenchymal transition.