Objective:To explore the factors leading to communication disorders in ICU patients during mechanical ventilation from the perspective of both patients and medical staff, and to use the theoretical framework of acceptability to identify the barriers that can be improved by intervention.Methods:Using the method of descriptive phenomenology from July to August 2022, 11 patients with mechanical ventilation and 8 medical staff in the comprehensive ICU of a Yuhuangding Hospital in Yantai were selected for interviews by the purpose sampling method, combined with participatory observation. The interviews of patients were conducted off ventilator. With Nvivo12.0 Plus software, the seven-step analysis method of Colaizzi phenomenology was adopted to summarize the theme and the theoretical framework of acceptability was used to identify the obstacle factors that could be improved by intervention.Results:The age of 11 patients was 18-46 years old, the duration of mechanical ventilation was 9.5-312.3 h. The age of 8 medical staff was 26-54 years old, the length of service in ICU was 2-30 years. A total of 14 themes were extracted. For patients: defensive mood, difficulty in presenting information, introverted personality, communication tools are hard to use, emergency treatment conflict, deny the ability to communicate, thought slowness. For medical staff: defensive mood, cognitive load, high time cost, lack of humane communication strategies, poor training, other priorities, loss of confidence in effective communication, awareness of the importance of communication was not enough.Conclusions:There are many factors that can be improved for patients with mechanical ventilation in ICU. It is suggested to speed up the research and development of high-tech and personalized alternative communication tools in China, reduce negative communication between doctors and patients and nurses and patients, and implement evidence-based multi-mode and progressive communication intervention strategies.

Objective: To analyze the status of colorectal cancer screening results in Shangcheng District, Hangzhou City from 2020 to 2022, so as to provide the evidence for developing prevention and control strategies for colorectal cancer. Methods: According to Colorectal Cancer Screening Program for Zhejiang Key Populations, residents registered in Shangcheng District and at ages of 50 to 74 years were recruited and screened using Zhejiang Provincial Questionnaires for Assessment of Risk of Colorectal Cancer Screening among High-risk Populations and fecal immunochemical test (FIT). Residents positive for questionnaires or FIT, or both positive for questionnaires and FIT were served as a positive screening and colonoscopy should be underwent. The rates of positive screening, compliance of colonoscopy and different pathological diagnosis results were analyzed. Results: Totally 118 227 residents were screened in Shangcheng District from 2020 to 2022, with a positive rate of 16.00%. The positive rates of questionnaires, FIT and both questionnaires and FIT were 8.14%, 6.46% and 1.40%, respectively. Colonoscopy was performed among 6 501 cases, with a compliance rate of 34.37%. Colonoscopy detected 3 689 cases with colorectal lesions, with a detection rate of 56.75%. The detection rates of colorectal cancer, pericancer lesions and other benign lesions were 1.12%, 9.15% and 46.47%, respectively. The detection rates of positive screening, colorectal lesions and pericancer lesions were higher in men (22.16%, 61.25% and 12.45%) than those in women (11.62%, 51.98% and 5.67%; all P<0.05). The detection rates of positive screening, colorectal lesions, colorectal cancer and pericancer lesions appeared a tendency towards a rise with age (all P<0.05). The detection rates of positive screening and colorectal lesions appeared a tendency towards a decline, and the compliance rate of colonoscopy appeared a tendency towards a rise from 2020 to 2022 (all P<0.05). The detection rate of pericancer lesions was higher among questionnaire and FIT positive residents (65.37%, P<0.05). Conclusions The detection rates of colorectal cancer and pericancer lesions in Shangcheng District from 2020 to 2022 were 1.12% and 9.15%, respectively. Men, the elderly, questionnaire and FIT positive residents are key populations, and the compliance of colonoscopy for the populations should be improved.

Purpose To construct the model of differentiating primary central nervous system lymphoma(PCNSL)and atypical glioblastoma(GBM)by combining multi-parameter MRI radiomics and six machine learning algorithms,thus to compare the diagnostic efficacy of different machine learning algorithms.Materials and Methods The clinical and imaging data of 77(125 lesions)PCNSL and 90 atypical GBM(108 lesions)from PLA General Hospital and public databases were retrospectively analyzed from January 2013 to December 2023,and all patients were randomly divided into a training set(163 cases)and a validation set(70 cases)according to 7∶3.T1WI,T2WI and T1-weighted contrast-enhanced sequences were selected for tumor segmentation,and 1 132 radiomics features were extracted from each region of interest.The intraclass correlation coefficient(ICC)was used for the consistency test,and image features with ICC≥0.85 were selected.ICC and recursive feature elimination were used to select the best radiomics features.Six classifiers were used to train and verify three single sequence feature sets,three double-sequence sets and one multi-sequence set.The receiver operating characteristic curve was used to evaluate the diagnostic efficacy of the model.Results The combination model of the support vector machine of radial basis function classifier and multi-sequence feature set were the best model for differentiating PCNSL and atypical GBM.The area under the curve of the training set and the validation set were 0.969 and 0.913,respectively;and the accuracy were both 0.886.Conclusion Noninvasive extraction of multiparametric MRI features combined with machine learning algorithms can effectively differentiate PCNSL and atypical GBM,which provides support for the development of individualized treatment plans for patients.

Objective:To investigate the short-term and long-term efficacy and adverse reactions of neoadjuvant short-course radiotherapy combined with consolidation chemotherapy for locally advanced rectal cancer.Methods:A retrospective cohort study was conducted. One hundred and fifty patients with stage Ⅱ-Ⅲ rectal cancer who underwent total rectal mesentery resection in Shanxi Province Cancer Hospital from August 2015 to August 2018 were selected and divided into the short-course radiotherapy combined with consolidation chemotherapy group (study group) and the long-course synchronous radiotherapy and chemotherapy group (control group) according to the mode of neoadjuvant radiochemotherapy, with 71 and 79 cases in each group respectively. The two groups were compared in terms of recent efficacy and occurrence of adverse reactions. Kaplan-Meier method was used for survival analysis.Results:There were no statistically significant differences in the baseline clinicopathological characteristics of patients between the two groups (all P > 0.05). The proportion of patients with descending T stage [71.8% (51/71) vs. 55.7% (44/79)], descending clinical stage [66.2% (47/71) vs. 49.4% (39/79)] and the rate of pathological complete remission [21.1% (15/71) vs. 8.9% (7/79)] in the study group were higher than those in the control group, and the differences were statistically significant (all P < 0.05). The distant metastasis-free survival (DMFS) of the study group was better than that of the control group (3-year DMFS rate: 80.3% vs. 68.4%), and the difference was statistically significant ( χ2 = 4.19, P = 0.041); the differences between the study group and the control group in terms of disease-free survival (DFS) (3-year DFS rate: 80.3% vs. 78.5%) and overall survival (OS) (5-year OS rate: 91.5% vs. 83.4%) were not statistically significant (both P > 0.05). The differences in the incidences of nausea and vomiting, diarrhoea, bone marrow suppression and malaise between the two groups were not statistically significant (all P > 0.05). Conclusions:Neoadjuvant short-course radiotherapy combined with consolidation chemotherapy for locally advanced rectal cancer is safe and effective.

Isoenzymes

Objective:To classified the fluid location of of grade B and C postoperative pancreatic fistula (POPF) and propose processing flow.Methods:Data from 232 patients who underwent pancreatic surgery from January 2018 to December 2022 at Department of General Surgery & Hepato-billo-pancreatic,Beijing Hospital were collected retrospectively. Forty-six patients who suffered from grade B and C POPF underwent ultrasound-guided drainage. There were 32 males and 14 females, with an age of (60.2±13.7)years (range:18 to 85 years). The imaging data of postoperative CT were collected and the the fluid location was classified. Then analyzed the drainage status when patents were diagnosed as POPF. Machine learning was performed and a random forest model was applied to construct the relationship between intervention time and mortality. The optimal intervention time was calculated. The patients were then divided into early and late intervention groups and clinical data and outcomes were compared using the t test,Mann-Whitney U test, χ2 test or Fisher′s exact test between the two groups. Results:Based on the results of the random forest model, the optimal puncture time was within 5.38 days after the diagnosis of POPF. Based on the optimal time, 21 patients were subsumed into early intervention group and 25 patients were subsumed into late intervention group. The location of fluid collection was classified into four types: peripancreatic (32.7%,15/46), extra-pancreatic and epigastric (41.3%,19/46), extra-pancreatic and hypogastic (13.0%,6/46) and diffused (13.0%,6/46). The status of the drainage included normal in 10 patients (21.8%), displaced drain in 18 patients (39.1%) and drain removed or blocked in 18 patients (39.1%). The perioperative mortality rate was 19.0% (4/21) in the early intervention group and 8.0%(2/25) in the late. The late intervention group had significantly higher rates of positive drainage fluid cultures (88.0%(22/25) vs. 42.9%(10/21), χ2=10.584, P=0.001), secondary surgery (24.0%(6/25) vs. 0(0/21), P=0.025), and readmission within 90 days(32.0%(8/25) vs. 4.8%(1/21), χ2=5.381, P=0.020) than the early group, and a significantly longer postoperative hospital stay( M(IQR))(24(20)days vs. 39(53)days, Z=3.023, P=0.003). Conclusions:The location of the POPF fluid collection is classified into four types. Early radiological evaluation can detect abdominal effusion promptly,and early puncture and drainage will be beneficial in improving outcomes in these patents.

Objective:To classified the fluid location of of grade B and C postoperative pancreatic fistula (POPF) and propose processing flow.Methods:Data from 232 patients who underwent pancreatic surgery from January 2018 to December 2022 at Department of General Surgery & Hepato-billo-pancreatic,Beijing Hospital were collected retrospectively. Forty-six patients who suffered from grade B and C POPF underwent ultrasound-guided drainage. There were 32 males and 14 females, with an age of (60.2±13.7)years (range:18 to 85 years). The imaging data of postoperative CT were collected and the the fluid location was classified. Then analyzed the drainage status when patents were diagnosed as POPF. Machine learning was performed and a random forest model was applied to construct the relationship between intervention time and mortality. The optimal intervention time was calculated. The patients were then divided into early and late intervention groups and clinical data and outcomes were compared using the t test,Mann-Whitney U test, χ2 test or Fisher′s exact test between the two groups. Results:Based on the results of the random forest model, the optimal puncture time was within 5.38 days after the diagnosis of POPF. Based on the optimal time, 21 patients were subsumed into early intervention group and 25 patients were subsumed into late intervention group. The location of fluid collection was classified into four types: peripancreatic (32.7%,15/46), extra-pancreatic and epigastric (41.3%,19/46), extra-pancreatic and hypogastic (13.0%,6/46) and diffused (13.0%,6/46). The status of the drainage included normal in 10 patients (21.8%), displaced drain in 18 patients (39.1%) and drain removed or blocked in 18 patients (39.1%). The perioperative mortality rate was 19.0% (4/21) in the early intervention group and 8.0%(2/25) in the late. The late intervention group had significantly higher rates of positive drainage fluid cultures (88.0%(22/25) vs. 42.9%(10/21), χ2=10.584, P=0.001), secondary surgery (24.0%(6/25) vs. 0(0/21), P=0.025), and readmission within 90 days(32.0%(8/25) vs. 4.8%(1/21), χ2=5.381, P=0.020) than the early group, and a significantly longer postoperative hospital stay( M(IQR))(24(20)days vs. 39(53)days, Z=3.023, P=0.003). Conclusions:The location of the POPF fluid collection is classified into four types. Early radiological evaluation can detect abdominal effusion promptly,and early puncture and drainage will be beneficial in improving outcomes in these patents.

ObjectiveTo obtain content characteristics of inorganic elements in Scutellariae Radix （aged 1-4 years）， and to explore the feasibility of identifying the growth years of Scutellariae Radix based on characteristic spectrum of inorganic elements combined with chemometric models. MethodAfter microwave digestion， the contents of Mn， Zn， Ca， Fe， Mg， Na， K， Cr， Cu， Se， As， Cd， Hg， Pb and Ni in 21 batches of Scutellariae Radix were determined by inductively coupled plasma atomic emission spectrometry （ICP-OES） and inductively coupled plasma mass spectrometry （ICP-MS）. Meanwhile， characteristic spectrum of inorganic elements in samples was drawn. The identification model was constructed to discriminate the growth years of Scutellariae Radix based on the combination of principal component analysis （PCA）， Fisher discriminant function and support vector machine （SVM）. ResultThe contents of Mn （7.79-36.48 μg·g^-1）， Zn （10.12-31.43 μg·g^-1）， Cu （6.38-17.20 μg·g^-1）， K （2.98-13.89 μg·g^-1）， Mg （3.45-7.78 μg·g^-1） and Ca （2.32-7.09 μg·g^-1） in Scutellariae Radix were detected by ICP-OES and ICP-MS， and their contents increased with the prolongation of growth years. PCA results showed that Cu， Ni， Cd， Na， Mg， Fe， Ca， Zn， Mn and Hg were characteristic elements of Scutellariae Radix. Samples with different years could be divided into four categories in the spatial characteristic diagram of Fisher discriminant analysis. The correct rate of SVM model for identifying the growth years of samples was 95.2%. ConclusionThis established method is accurate and rapid for discriminating the growth years of Scutellariae Radix， which can provide reference for the identification of other Chinese medicinal materials. It is suggested that some elements should be considered as indexes in subsequent construction of the quality evaluation system of Scutellariae Radix.

Objective and MethodChemical components in four varieties of Moringa Folium （MF）； traditional Indian YD， modified species of Indian species PKM1， modified species of PKM1 species PKM2， and red river No.1 variety HH） were qualitatively analyzed by ultra-high performance liquid chromatography quadrupole time of flight mass spectrometry（UPLC-Q-TOF-MS） and gas chromatography mass spectrometry（GC-MS）， and potential mechanism and material basis of MF in the treatment of constipation were revealed based on network pharmacology. ResultData of accurate relative molecular mass and fragment ions in primary and secondary mass spectra in both positive and negative ion modes were acquired by UPLC-Q-TOF-MS， and then 20 nonvolatile components were identified from the four varieties by comparison with references and consulting literature reports. Nineteen volatile components were identified by comparing mass spectrometry information and that in NIST （version 1.7） based on GC-MS， and 674 chemical component targets were predicted using SwissTargetPrediction and SEA after integration and duplicate elimination. A total of 1 086 constipation-related targets were predicted using GeneCards. With Venny， 88 intersection targets were obtained by mapping chemical component targets and disease targets and venny diagram was drawn. STRING and Cytoscape were used to plot protein-protein interaction（PPI） network diagram. Gene ontology（GO） function analysis and Kyoto encyclopedia of genes and genomes（KEGG） pathway analysis were completed through Metascape， which indicated that MF treated constipation mainly via thyroid hormone signaling pathway， advanced glycation end products/receptor for advanced glycation end products（AGE/RAGE） signaling pathway， and cancer signaling pathway. Additionally， the "component-target-pathway" map was plotted by Cytoscape， which predicted that the key components of MF in the treatment of constipation were adenosine， astragalin， geranylacetone， 2-methyloctan-3-one， palmitic acid and oleamide. Also， we inferred that the core targets might be prostaglandin-endoperoxide synthase 2（PTGS2）， tumor necrosis factor（TNF）， mitogen-activated protein kinase 1（MAPK1）， alpha 2A adrenergic receptor（ADRA2A）， and interleukin （IL）-6， which distributed in multiple tissues such as colon， small intestine， and rectum. ConclusionThis study clarified the volatile and non-volatile divisions in four varieties of MF comprehensively， and explained that MF treated constipation by reducing inflammatory state and promoting intestinal movement and secretion of intestinal fluid， which provided reference for further quality evaluation and clinical research of MF.

Objective:To analyze the disaster vulnerability of hospitals in Macao Special Administrative Region to assess the disaster risk objectively, so as to provide reference for Macao hospitals to formulate their emergency plans and improve their emergency response and handling capacity.Methods:From December 2021 to February 2022, 118 medical staff were selected for a questionnaire survey using the method of departmental stratified random sampling from three general hospitals in Macao. At the same time, 7 full-time medical staff and 2 experts in the field of health care were selected for expert consultation. The main content of the questionnaire was the hospital disaster risk assessment based on the Kaiser model, and three-round expert consultation method was used to determine the model indicators. The risk value of each indicator was calculated to analyze the hospital disaster vulnerability.Results:107 valid questionnaires were collected. The top five events in the hospital disaster risk value were typhoon(52.42%), large-scale public health events/epidemic outbreaks(47.55%), strong thunderstorm convective weather(38.68%), extreme temperature(37.31%) and information system failure(33.75%). As ranked by the total risk value, the categories of hospital disasters were natural disasters(35.69%), information security(29.49%), medical technology accidents(29.36%), equipment technology accidents(26.25%), dangerous goods injuries(25.13%) and personnel injuries(19.98%).Conclusions:Macao hospitals are exposed to the highest total risk value in natural disasters, followed by information security. In addition, the risk value of large-scale public health events and epidemic outbreaks of personal injury is also so high as to deserve attention. Macao hospitals should formulate effective emergency response plans according to the risk values of various disasters and the actual situation of each medical department, so as to minimize the losses caused by disasters to both hospitals and patients.