Background::Pathological scars are a disorder that can lead to various cosmetic, psychological, and functional problems, and no effective assessment methods are currently available. Assessment and treatment of pathological scars are based on cutaneous manifestations. A two-photon microscope (TPM) with the potential for real-time non-invasive assessment may help determine the under-surface pathophysiological conditions in vivo. This study used a portable handheld TPM to image epidermal cells and dermal collagen structures in pathological scars and normal skin in vivo to evaluate the effectiveness of treatment in scar patients. Methods::Fifteen patients with pathological scars and three healthy controls were recruited. Imaging was performed using a portable handheld TPM. Five indexes were extracted from two dimensional (2D) and three dimensional (3D) perspectives, including collagen depth, dermo-epidermal junction (DEJ) contour ratio, thickness, orientation, and occupation (proportion of collagen fibers in the field of view) of collagen. Two depth-dependent indexes were computed through the 3D second harmonic generation image and three morphology-related indexes from the 2D images. We assessed index differences between scar and normal skin and changes before and after treatment.Results::Pathological scars and normal skin differed markedly regarding the epidermal morphological structure and the spectral characteristics of collagen fibers. Five indexes were employed to distinguish between normal skin and scar tissue. Statistically significant differences were found in average depth ( t = 9.917, P <0.001), thickness ( t = 4.037, P <0.001), occupation ( t= 2.169, P <0.050), orientation of collagen ( t = 3.669, P <0.001), and the DEJ contour ratio ( t = 5.105, P <0.001). Conclusions::Use of portable handheld TPM can distinguish collagen from skin tissues; thus, it is more suitable for scar imaging than reflectance confocal microscopy. Thus, a TPM may be an auxiliary tool for scar treatment selection and assessing treatment efficacy.

Objective To investigate the characteristics and clinicopathology of v-raf murine sarcoma viral oncogene homolog Bl(BRAF)V600E mutations in papillary thyroid carcinoma(PTC)in Air Force flight personnel.Methods Data of cases and test results of BRAF V600E mutation were collected from Air Force aviators pathologically diagnosed with PTC.A univariate analysis of the relationship between BRAF V600E mutations and clinicopathologic features was performed.Results The overall rate of BRAF V600E mutations among 55 PTC flight crew members was 70.91％.The univariate analysis showed that the number of lymph node metastases in the BRAF V600E mutated group was larger than in the BRAF V600E unmutated group,and the proportion of BRAF V600E mutations in flight crews at intermediate risk of recurrence was higher than that in those at low risk of recurrence(P＜0.05).The presence or absence of BRAF V600E mutations did not affect the results of medical evaluation of PTC in flight personnel.Conclusion The rate of PTC BRAF V600E mutations in Air Force flight crews is similar to that of the general Chinese population.BRAF V600E mutations are associated with an increased number of lymph node metastases and risk of recurrence,and follow-up is recommended for flight personnel with PTC,especially those with BRAF V600E mutations.

Postoperative nausea and vomiting(PONV)is a common complication of general anes-thesia.PONV makes negative influence on recovery and prolongs hospital stays.In addition toantiemetic prophylaxis,electrical acupoint stimulation(EAS)has been widely applied in clinical scenario and signifi-cantly reduces PONV incidence,but its mechanism,stimulation parameters,and combined efficacy with pharmacological strategy remain unclear.This article reviews the stimulation parameters,efficacy,safety,and mechanism of EAS for PONV prevention.This review aims to provide insights for future studies.

Objective To observe the effects of different surgical approaches on the complications and tumor markers of patients undergoing radical resection of esophageal cancer.Method A prospective study was conducted on 100 patients with esophageal cancer who underwent radical surgery in our hospital from October 2019 to October 2022.They were randomly divided into an observation group and a control group using a random number table method,with 50 patients in each group,he right thoracic approach was used in the observation group and the left thoracic approach was used in the control group.Perioperative indexes,inflammatory factors[Substance P(SP),hypersensitive C-reactive protein(hs-CRP),interleukin6(IL-6)],tumor markers[cytokeratin 19 fragment antigen(CYFRA21-1),squamous cell carcinoma antigen(SCC-Ag)and carbohydrate antigen 199(CA199)]and lung function of the two groups were compared before and after surgery Indicators[vital capacity(VC),forced vital capacity(FVC),and forced expiratory volume in the first second(FEV1)]and complication rate.Result The operating time,blood loss,indwelling time,hospitalization time,and number of lymph node dissection in the observation group were(247.65±27.33)minutes,(211.82±25.49)ml,(6.97±2.12)days,(16.11±3.81)days,and(19.67±5.21),respectively,which were higher than those in the control group[(217.63±23.69)minutes,(175.67±22.13)ml,(5.43±1.80)days,(12.68±3.24)days,(15.45±4.12)](P＜0.05).On average,there was a significant increase in SP,hs CRP,and IL-6 levels in both groups 3 days after surgery(P＜0.05).The levels of SP,hs CRP,and IL-6 in the observation group were(273.96±35.45)ng/L,(11.35±2.12)mg/L,and(8.19±1.67)p.g/ml,respectively,which were lower than the control group[(298.33±38.42)ng/L,(14.29±2.68)mg/L,(10.35±1.82)pg/ml](P＜0.05);One month after surgery,there was a significant decrease in CYFRA21-1,SCC-Ag,and CA199 in both groups(P＜0.05),and in the observation group,the data of CYFRA21-1,SCC-Ag,and CA199 were(2.59±0.37)μg/L,(45.62±6.18)pg/L and(59.37±6.12)U/ml,respectively,which were lower than those in the control group[(3.12±0.43)μg/L,(60.27±7.35)pig/L,(63.28±6.49)U/ml](P＜0.05);One month after surgery,there was a significant decrease in VC,FVC,and FEV1 in both groups(P＜0.05).However,the VC,FVC,and FEV1 in the observation group were(67.21±8.69)％,(70.33±9.41)％,and(72.88±10.12)％,respectively,which were higher than those in the control group[(54.35±8.27)％,(61.65±8.79)％,(65.37±9.24)％](P＜0.05).There was no significant difference in the incidence of complications between the two groups(P＞0.05).Conclusion Both approaches can effectively treat esophageal cancer.Among them,the right chest approach can significantly improve the effect of lymph node dissection,inhibit inflammatory reactions,reduce tumor marker levels,and have less impact on lung function,without significantly increasing the risk of complications.However,the surgical time,bleeding volume,and postoperative recovery time are relatively long.Therefore,a suitable approach should be selected in clinical practice based on the patient's actual situation.

Objective:To describe the detail sampling design,weighting,instruments,filed procedures and quality control methods of the epidemiological survey on dementia among community residents in Tongliao City.Methods:A three-stage disproportionate probability sampling design was used to investigate the inhabitants aged 65 years and over in Tongliao City,Inner Mongolia Autonomous Region.The 10/66 Dementia Research Group(10/66 DRG)assessment instruments were used to diagnose dementia,using computer-assisted personal interview mode in the selected older people.Comprehensive quality control methods were implemented throughout the field-work.Results:A total of 166 villages or communities were sampled from nine counties or districts in Tongliao Cit-y.Totally 4 345 older people were interviewed with 96.2％response rate.By calculating sampling design weights,non-response adjustment weights and post-stratification adjustment weights,these weights were multiplied and per-formed trimming adjustment and standardization adjustment to generate final weights.The 171 interviewers were well-trained and qualified to carry out filed interview.Quality control methods included computer data check,audio record check,and telephone check in order to ensure the quality of the survey.Conclusion:This survey is imple-mented using a rigorous sampling design and timely quality control methods,and uses the 10/66 DRG assessment instruments with satisfactory international validity and reliability as survey instruments,which has international cross-cultural comparability.It provides a valid and feasible methodology of epidemiological survey on dementia for further studies in different regions in China.

Objective: To investigate the potential association among preoperative breast MRI features, axillary nodal burden (ANB), and disease-free survival (DFS) in patients with early-stage breast cancer. Materials and Methods: We retrospectively reviewed 297 patients with early-stage breast cancer (cT1-2N0M0) who underwent preoperative MRI between December 2016 and December 2018. Based on the number of positive axillary lymph nodes (LNs) determined by postoperative pathology, the patients were divided into high nodal burden (HNB; ≥3 positive LNs) and non-HNB (<3 positive LNs) groups. Univariable and multivariable logistic regression analyses were performed to identify independent risk factors associated with ANB. Predictive efficacy was evaluated using the receiver operating characteristic (ROC) curve and area under the curve (AUC). Univariable and multivariable Cox proportional hazards regression analyses were performed to determine preoperative features associated with DFS. Results: We included 47 and 250 patients in the HNB and non-HNB groups, respectively. Multivariable logistic regression analysis revealed that multifocality/multicentricity (adjusted odds ratio [OR] = 3.905, 95% confidence interval [CI]: 1.685– 9.051, P= 0.001) and peritumoral edema (adjusted OR = 3.734, 95% CI: 1.644–8.479, P = 0.002) were independent risk factors for HNB. Combined peritumoral edema and multifocality/multicentricity achieved an AUC of 0.760 (95% CI: 0.707– 0.807) for predicting HNB, with a sensitivity and specificity of 83.0% and 63.2%, respectively. During the median follow-up period of 45 months (range, 5–61 months), 26 cases (8.75%) of breast cancer recurrence were observed. Multivariable Cox proportional hazards regression analysis indicated that younger age (adjusted hazard ratio [HR] = 3.166, 95% CI: 1.200–8.352, P= 0.021), larger tumor size (adjusted HR = 4.370, 95% CI: 1.671–11.428, P= 0.002), and multifocality/multicentricity (adjusted HR = 5.059, 95% CI: 2.166–11.818, P< 0.001) were independently associated with DFS. Conclusion Preoperative breast MRI features may be associated with ANB and DFS in patients with early-stage breast cancer.

Objective:To investigate the current situation of health emergency response literacy among emergency nurses, analyze the potential profile of emergency nurses′ health emergency response literacy and explore the influencing factors of different categories, so as to provide reference for formulating targeted and specific training intervention programs.Methods:From September to October 2022, 386 emergency nurses from 5 tertiary A-level hospitals in Shandong Province were selected as the research objects by convenient sampling method. A cross-sectional survey was conducted by using the general information questionnaire, the Literacy Self-assessment Scale of Public Health Emergency Response In Nurses, the Chinese version of Modified Self-leadership Questionnaire, and Nurse Perceived Professional Value Scale. The latent profile analysis was carried out with the results of 3 explicit indexes of the Literacy Self-assessment Scale of Public Health Emergency Response In Nurses. At the same time, the influencing factors of different latent profiles of health emergency literacy were explored by univariate analysis and ordered multi-classification Logistic regression.Results:The health emergency literacy of emergency department nurses was divided into three latent profiles: high health emergency literacy type accounting for 45.4% (175/386), medium health emergency literacy type accounting for 41.5% (160/386), and low health emergency literacy type accounting for 13.1% (51/386). Ordinal Logistic regression showed that the main emergency work post was pre hospital first aid, participated in public health emergency rescue operations, self leadership, and professional value were protective factors of health emergency literacy (all P<0.05). Age≤25 years old and junior college degree were risk factors of health emergency literacy (both P<0.05). Conclusions:Nursing managers can implement personalized training and intervention strategies according to different demographic characteristics of the health emergency literacy of emergency nurses, develop self leadership improvement plans from individual and organizational factors, and actively cultivate their sense of professional value, in order to comprehensively improve the health emergency literacy of emergency nurses.

Objective:To observe the effects of 0.01% atropine eye drops on ocular biometrics in myopic adolescents.Methods:A prospective cohort study was conducted.Two hundred and nineteen myopic adolescents who visited the First Affiliated Hospital of Zhengzhou University from June 2016 to June 2017 and completed the 1-year follow-up on time were enrolled.The 219 adolescents were divided into a 0.01% atropine+ single-vision spectacles (SV) group (119 cases) wearing single-vision spectacles with one drop of atropine eye drop applied to both eyes once nightly, and a simple SV group (100 cases) wearing SV only.Axial length (AL), corneal power and anterior chamber depth were measured with the IOLMaster.Lens power was calculated using the Bennett-Rabbetts formula.Intraocular pressure was measured by non-contact tonometry.Spherical equivalent (SE) was examined by cycloplegic autorefraction.Total astigmatism and corneal astigmatism were calculated by vector decomposition.The right eye data were analyzed to compare the ocular biometrics changes between the two groups, and multiple linear regression analysis was used to evaluate the influencing factors.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of First Affiliated Hospital of Zhengzhou University (No.2016-35). Written informed consent was obtained from guardians before any medical examination.Results:The SE change and AL elongation 12 months after treatment in 0.01% atropine+ SV group were (-0.47±0.45) D and (0.37±0.22) mm, respectively, which were significantly lower than (-0.70±0.60)D and (0.46±0.35)mm in simple SV group ( t=5.523, 9.651; both at P<0.001). There were significant differences in SE and AL between before and after treatment in both groups (SE: Fgroup=1.556, P=0.015; Ftime=12.538, P=0.002; AL: Fgroup=3.425, P=0.021; Ftime=18.235, P=0.008). The SE and AL at 4, 8 and 12 months after treatment were all increased in comparison with before treatment in both groups, showing statistically significant differences (all at P<0.001). The SE and AL at 8 and 12 months after treatment in 0.01% atropine+ SV group were smaller than in simple SV group, and the differences were statistically significant (all at P<0.001). At 8 and 12 months after treatment, total astigmatism and the anterior chamber depth were increased and the lens power was decreased in comparison with before treatment in both groups, and the differences were statistically significant (all at P<0.05). There was no significant difference in corneal astigmatism, corneal power and intraocular pressure at different time points before and after treatment between the two groups (all at P>0.05). In the multiple linear regression analysis, an equation of Δmyopic SE=-0.012-2.685×ΔAL-1.002×Δcorneal astigmatism-0.656×Δlens power+ 0.477×Δtotal astigmatism+ 0.363×Δanterior chamber depth-0.060×age+ 0.011×sex was used, showing the change of SE was mainly caused by the change of AL ( β=-2.685), then corneal power, lens power, total astigmatism and anterior chamber depth. Conclusions:In adolescents, 0.01% atropine eye drops can effectively retard myopia progression and axial elongation, showing no effect on astigmatism, corneal power, lens power, anterior chamber depth and intraocular pressure.The controlling effect of 0.01% atropine eye drops in the development of myopia is mainly achieved by reducing axial elongation.

Objective:To investigate the value of preoperative breast MRI combined with axillary ultrasound in predicting lymphovascular invasion (LVI) of breast invasive ductal carcinoma.Methods:The clinical, pathological and imaging features of 160 female patients [age 25-74(49±10)years] with breast invasive ductal carcinoma from March 2014 to December 2017 in Shanxi Cancer Hospital were retrospectively analyzed. According to the LVI status determined by postoperative pathology, 160 patients were divided into LVI positive group (56 cases) and LVI negative group (104 cases). The clinical characteristics, pathological characteristics and imaging features of LVI positive group and LVI negative group were compared by the independent t test, Mann-Whitney U test or χ 2 test. Multivariate logistic regression analysis was performed to identify independent predictors for predicting LVI and construct a predictive model. The receiver operating characteristic (ROC) curve and area under the curve (AUC) was used to evaluate the discrimination of the prediction model, and the Hosmer-Lemeshow test was used to evaluate its calibration. Results:There was no significant difference in age, menopausal status, estrogen receptor, progesterone receptor, human epidermal growth factor 2, Ki67 index and molecular subtype between LVI positive group and negative group ( P>0.05). Tumor size, peritumoral edema, adjacent vessel sign, multifocality or multicentricity, peritumoral maximum-apparent diffusion coefficient (ADC), peritumour-tumour ADC ratio, MRI axillary lymph node status and ultrasound axillary lymph node status between LVI positive group and LVI negative group showed significantly statistical difference ( P<0.05). Variables with significant difference in the univariate analysis were entered into multivariate logistic regression analysis to explore predictors for LVI. Peritumoral edema (OR=3.367, 95%CI 1.382-8.201, P=0.008), multifocality or multicentricity (OR=4.026, 95%CI 1.268-12.776, P=0.018), high peritumoral-tumor ADC ratio (OR=7.321, 95%CI 2.226-24.079, P=0.001) and positive ultrasound axillary lymph node (OR=6.779, 95%CI 2.819-16.303, P<0.001) were independent predictors for predicting LVI. A logistic regression model was constructed using the above four indicators, and ROC showed AUC of this model for predicting LVI was 0.882, superior to any of the single indicator ( P<0.05); its sensitivity was 80.36% and specificity was 84.62%. Hosmer-lemeshow test showed that the prediction model had good calibration ( P=0.503). Conclusion:The combined prediction model constructed by preoperative breast MRI and axillary ultrasound could help to predict the LVI status of breast invasive ductal carcinoma.

Objective To investigate the effect of exosomes derived from Echinococcus multilocularis on macrophage polarization after treatment for different durations and concentrations. Methods A total of 60 BALB/c mice were used for modeling, among which 4 mice were selected to observe the growth of abdominal lesions on 7.0T MRI. The mice for modeling were dissected, and the protoscoleces was taken from the abdominal lesion and cultured in vitro ; ultracentrifugation was used to extract the exosomes from the supernatant, and transmission electron microscopy and Western blotting were used for the characterization of exosomes. The macrophages without exosome treatment were established as control group, and the macrophages co-cultured with different concentrations of exosomes derived from Echinococcus multilocularis were established as experimental group (10 μg/mL group and 50 μg/mL group) and were cultured for 48 and 72 hours. The morphological changes of macrophages were observed under a microscope, and flow cytometry and ELISA were used to observe polarization state. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups, and the least significant difference t -test was used for further comparison between two groups. Results The results of 7.0T MRI showed the formation of diffuse lesions with different sizes in the abdominal cavity of mice, and the exosomes derived from Echinococcus multilocularis were approximately 100 nm in diameter and were cup-shaped or saucer-shaped, with the positive expression of the surface markers CD9, TSG101, and CD63. After co-culture, most of the cells in the experimental group were elongated with an irregular and polygonal shape. Flow cytometry showed that after 48 hours of co-culture, the positive rates of CD16/32, CD206, and CD369 in the control group were 99.53%±0.06%, 90.27%±0.21%, and 2.40%±0.20%, respectively; compared with the control group, except that the 10 μg/mL exosome group had a significant reduction in the positive rate of CD369 (0.80%±0.00%) ( P < 0.05), all the other groups had a significant increase in the positive rates of CD16/32, CD206, and CD369 (all P < 0.000 1); after 72 hours of co-culture, the positive rates of CD16/32, CD206, and CD369 in the control group were 99.67%±0.06%, 85.47%±0.55%, and 6.60%±0.20%, respectively, and compared with the control group, the experimental group had significant increases in the positive rates of CD16/32, CD206, and CD369 (all P < 0.05). ELISA showed that after 48 hours of co-culture, the levels of IL-6 and TNFα in the control group were 58.53±15.52 pg/mL and 320.70±5.30 pg/mL, respectively, and when the exosome concentration was 50 μg/mL, the level of IL-6 in the experimental group was 98.81±15.55 pg/mL, which was higher than that in the control group ( P < 0.05); after 72 hours of co-culture, the levels of IL-6 and TNFα in the control group were 76.22±9.68 pg/mL and 323.90±87.37 pg/mL, respectively, and when the exosome concentration was 10 μg/mL, the level of TNFα was 164.20±14.17 pg/mL, which was significantly lower than that in the control group ( P < 0.05); when the exosome concentration was 50 μg/mL, the level of IL-6 was 99.52±8.35 pg/mL, which was significantly higher than that in the control group ( P < 0.05). Conclusion Exosomes derived from Echinococcus multilocularis can regulate macrophage polarization and induce M2-like polarization of macrophages after co-culture at a concentration of 10 μg /mL for 72 hours, and further studies are needed to clarify the specific method.