Objective·To evaluate the changes in cognitive function in overweight and obese adolescents,and explore the association between cognitive function and fibroblast growth factor 21(FGF21).Methods·A total of 175 adolescents from a senior high school in Shanghai were divided into normal weight group(n=50),overweight group(n=50)and obese group(n=75)based on their body mass index(BMI).General information,anthropometric data and laboratory testing indicators of the adolescents were collected and compared.The cognitive function of the three groups of adolescents was assessed by using the accuracy(ACC)and reaction time of Flanker task and n-back task.Enzyme-linked immunosorbent assay(ELISA)was used to detect the serum FGF21 level of the three groups of adolescents.Partial correlation analysis and multiple linear regression model were used to evaluate the correlation between cognitive task performance and anthropometric data and laboratory testing indicators.Results·Compared with the normal weight group,systolic blood pressure,diastolic blood pressure,and the levels of fasting plasma glucose,glycosylated hemoglobin and triacylglycerol in the obese group were higher(all P<0.05).Under congruent or incongruent stimulus conditions in the Flanker task,there was no significant difference in ACC between any two groups;compared with the normal weight and overweight groups,the reaction time of the adolescents in the obese group was prolonged(all P<0.05).In the n-back task,there were no significant differences in ACC between any two groups,while the obese group had longer reaction time in the 1-back and 2-back tasks compared to the normal weight and overweight groups(all P<0.05).Compared with the normal weight group,serum FGF21 levels of the adolescents in the obese group were higher(P=0.000).Partial correlation analysis showed that the reaction time of the adolescents in Flanker and n-back tasks was correlated with their BMI,body fat mass,waist circumference,waist-to-hip ratio and FGF21 level(all P<0.05).Multiple linear regression analysis further confirmed that BMI was associated with prolonged reaction time in cognitive-related behavioral tasks in the adolescents(all P<0.05),and FGF21 level was associated with ACC in the 2-back task(P=0.000)and reaction time in the incongruent stimulus condition(P=0.048).Conclusion·Overweight and obese adolescents have cognitive impairments,and BMI and serum FGF21 levels are associated with changes in their cognitive function.

Objective To understand the current status and influencing factors of patient perception for humanistic care in China hospitals,and to provide a basis for developing nursing humanistic care measures and improving the quality of nursing humanistic care services.Methods A total of 30,099 outpatients and inpatients from 107 hospitals in 30 provinces(autonomous regions and municipalities)from July to August 2022 as survey subjects.A general information questionnaire and the Relational Caring Questionnaire-Patient Form were used for a cross-sectional survey,and a single-factor analysis was used to analyze the influencing factors of patient relationship care.Results Finally,29 108 valid questionnaires were collected,and the effective questionnaire recovery rate was 96.7％.The patient evaluation of relationship care was(65.72±8.61)points.Single-factor analysis showed that gender,age,marital status,children's situation,education level,occupation,place of residence,average family income,medical insurance type,visiting department,and location of the visiting hospital,and whether or not surgery were influencing factors of patient relationship care(P＜0.05).Conclusion The evaluation score of caregiver-patient relationship care among Chinese hospital patients is above average,but there is still room for improvement in western and rural regions,seriously ill and outpatient patients,low-income and low-medical insurance reimbursement populations,and non-surgical patients.Medical institutions at all levels should optimize and improve nursing humanistic care services based on influencing factors,and further enhance patients'perception of nursing humanistic care.

Objective To compare the effect of three-dimensional visual (3DV) model, three-dimensional printing (3DP) model and computer-aided design (CAD) modified 3DP model in video-assisted thoracoscopic surgery (VATS) sublobular resection. Methods The clinical data of patients who underwent VATS sublobular resection in the Affiliated Hospital of Hebei University from November 2021 to August 2022 were retrospectively analyzed. The patients were divided into 3 groups including a 3DV group, a 3DP group and a CAD-3DP group according to the tools used. The perioperative indexes and subjective evaluation of operators, patients and their families were compared. Results A total of 22 patients were included. There were 5 males and 17 females aged 32-77 (56.95±12.50) years. There were 9 patients in the 3DV group, 6 patients in the 3DP group, and 7 patients in the CAD-3DP group. There was no statistical difference in the operation time, intraoperative blood loss, drainage volume, hospital stay time or postoperative complications among the groups (P>0.05). Based on the subjective evaluations of 4 surgeons, the CAD-3DP group was better than the 3DV group in the preoperative planning efficiency (P=0.025), intuitiveness (P=0.045) and doctor-patient communication difficulty (P=0.034); the CAD-3DP group was also better than the 3DP group in the overall satisfaction (P=0.023), preoperative planning difficulty (P=0.046) and efficiency (P=0.014). Based on the subjective evaluations of patients and their families, the CAD-3DP group was better than the 3DP group in helping understand the vessel around the tumor (P=0.016), surgical procedure (P=0.020), procedure selection (P=0.029), and overall satisfaction (P=0.048); the CAD-3DP group was better than the 3DV group in helping understand the tumor size (P=0.038). Conclusion CAD-modified 3DP model has certain advantages in pre-planning, intraoperative navigation and doctor-patient communication in the VATS sublobectomy.

Objective: To monitor the prevelance of Neisseria meningitidis among healthy children and adolescents aged 3-18 in Anhui Province, so as to provide support for epidemic cerebrospinal meningitis prevention and control. Methods: From September to October in 2021 and 2022, 4 033 healthy children and adolescents aged 3-18 were selected by stratified random sampling from Anhui Province, including areas north of the Yangtze River (Bozhou, Fuyang, Bengbu, Huainan, Chuzhou, Hefei) and areas south of the Yangtze River (Wuhu, Maanshan, Tongling, Anqing, Chizhou, Xuancheng) and the secretions of children and adolescents were collected from the posterior pharyngeal wall above the uvula, and the strains were identified by bacterial culture and nucleic acid detection. McNemar test and Kappa consistency test were used for statistical analysis. Chisquare test and Chisquare trend test were used to compare the rates. Results: The carrier rates of Neisseria meningitidis were 0.47% and 1.07%, respectively. The sensitivity of nucleic acid detection was higher. Among the detected bacteria, group B accounted for the largest proportion of 76.74%. It was followed by group C (4.65%), group Y (4.65%), group W 135 (2.33%) and group X (2.33%). The bacteria bearing rate of male students was higher than that of female students (χ2=11.44); with the increase of age, the bacteria bearing rate of children and adolescents showed an increasing trend (χ2trend=42.69); the bacterial bearing rate of children and adolescents in the north of the Yangtze River was higher than that in the south of the Yangtze River (χ2=23.19); the bacteria bearing rate of children and adolescents without immune history was higher than that with immune history (χ2=11.02)(P<0.01). Conclusions Neisseria meningitidis group B has become an epidemic strain in Anhui Province, and senior children and adolescents have become the key population of epidemic prevention and control. It is necessary to continue to do a good job in the surveillance of epidemic cerebrospinal meningitis disease and focuse on group B disease cases, so as to prevent the occurrence of cluster outbreaks in schools.

Objective:To understand the epidemiology of rubella and the genetic characteristics of the virus circulating during the period 2021-2022, providing basic scientific data for rubella prevention and control in China.Methods:National rubella incidence data for the period 2021-2022 were obtained from the Infectious Disease Surveillance System module and the Surveillance Report Management module of the China′s Disease Prevention and Control Information System. Positive rubella virus(RuV)isolates were obtained from the National Measles/Rubella Laboratory Network. Two nucleotide (nt) fragments [F1-480 (8 633-9 112 nt) and F2-633 (8 945-9 577 nt)] located in the E1 gene were amplified and determined by reverse transcription polymerase chain reaction (RT-PCR), and the target gene (E1-739) was obtained after collating and splicing. The sequences obtained in this study were used to construct a phylogenetic tree with the reported reference strains for genotype and lineage identification. Additionally, the phylogenetic analysis was performed to assess their genetic relatedness of RuV strains prevalent in China during 2018-2020 from GenBank database.Results:In 2021-2022, the rubella incidence in China was 0.06/100, 000 (2021: 840 cases; 2022: 784 cases), with cases primarily concentrated in the western and southern provinces. Age distribution analysis showed that rubella cases in 2021-2022 was mainly in children under 5 years of age (2021: 34.17%, 287/840; 2022: 42.09%, 330/784), with the highest proportion in children aged 0-2 years. Further analysis of the immunization history of cases revealed that in the 8-23 months age group, a significant proportion of cases had received only one dose of rubella containing vaccine (RCV); cases in the 2-14 years age group were mainly among children who had received two or more doses of RCV; however, cases over 15 years of age were primarily found in individuals who had not received RCV or had unknown immunization history. National virological surveillance data showed that totally 22 RuV virus isolates were obtained, from 6 provinces in China during 2021-2022, which belonged to lineage 1E-L2 (11 strains) and 2B-L2c (11 strains). And these viruses displayed high genetic homology with RuV prevalent from 2018 to 2020.Conclusions:The incidence of rubella in China was maintained at a low level during 2021-2022, and the prevalent RuV strains were lineage 1E-L2 and 2B-L2c.

Objective: To investigate patients' satisfaction rate towards referral in a class A tertiary hospital, so as to provide the evidence for promoting the highly efficient implementation of referral. Methods : The gender, age, type of referral, referral efficiency and referral cost of patients receiving referral services in 2021 were collected through the interconnected intelligent hierarchical diagnosis and treatment collaborative platform of Henan Provincial People's Hospital. Patients' awareness and recognition of the two-way referral system were investigated using questionnaire surveys, and factors affecting patients' satisfaction with referral were identified using a multivariable logistic regression model. Results: A total of 1 268 patients receiving referral services were surveyed, including 576 men (45.43%) and 692 women (54.57%), and the respondents were predominant at ages of 18 years and older (935 cases, 73.74%). There were 535 cases with overdue referral (42.19%) and 1 157 cases with free referrals (91.25%). There were 749 cases that were aware of the two-way referral system (59.07%), and 587 cases recognized the two-way referral system (46.29%). There were 975 patients with a satisfactory attitude towards referral, with a satisfaction rate of 76.89%. There were 1 030 cases (81.23%) that considered fluent communication of referral information, with a 78.54% satisfaction rate towards referral; 569 cases (44.87%) that considered simple referral procedures, with an 81.37% satisfaction rate towards referral, and 797 cases that were satisfied with the services provided by the referred medical staff (62.85%), with a 79.42% satisfaction rate towards referral. Multivariable logistic regression analysis showed that non-overdue referrals (OR=1.846, 95%CI: 1.411-2.414), free referrals (OR=1.815, 95%CI: 1.188-2.773), awareness of the two-way referral system (OR=0.624, 95%CI: 0.472-0.826), recognition of the two-way referral system (OR=1.621, 95%CI: 1.235-2.129) were factors affecting the satisfaction with referral. Conclusions The satisfaction rate towards referral was 76.89% among the study patients, and the awareness and recognition of the two-way referral system, referral efficiency and convenience are factors affecting the satisfaction with referral.

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in the world, with the features of insidious onset, low surgical resection rate, and frequent early metastasis and recurrence. With the development of new molecular biology technology in recent years, a liquid biopsy technology, circulating tumor DNA (ctDNA) detection, has achieved encouraging results. This article reviews the current research status and future prospects of ctDNA as a key component of liquid biopsy in patients with HCC, in order to provide new ideas for the clinical treatment of HCC.

Cholangiocarcinoma is the most common malignant tumor of the biliary tract, with a relatively high mortality rate and an incidence rate increasing year by year. Due to atypical symptoms in the early stage and complex anatomical location, it is often difficult for patients with cholangiocarcinoma to be diagnosed in the early stage, and therefore, they often miss the optimal treatment period and tend to have poor prognosis. In recent years, studies have shown that miRNAs play a key role in the pathophysiological process of the development and progression of cholangiocarcinoma. This article reviews the regulatory role of miRNAs in the development, invasion, metastasis, drug resistance, and tumor microenvironment of cholangiocarcinoma and introduces the latest advances in exosome miRNA and cholangiocarcinoma, so as to provide potential treatment strategies for cholangiocarcinoma.

Objective To explore the phenomenon of gene silence of SLC5A8 in breast cancer.Methods Thirty-two patients suffered with breast cancer,hospitalized from June 2014 to June 2015 in affiliated hospital of Hebei university,were collected with the cancer tissue and normal specimen.Real-time quantitative PCR method was used to detect SLC5A8 gene transcription.Paired t-test and-test were used to anaylsed the results.Results Twenty cases of breast cancer tissues (62.5％) have no SLC5A8 gene transcription product,normal breast tissue adjacent to carcinoma specimens that had no product gene transcription was only five (12.5％).SLC5A8 inactivation rate of cancer tissue was significantly higher than normal tissue adjacent to carcinoma (P ＜ 0.05).The SLC5A8 mRNA transcription level of cancer tissue was significantly lower than the normal (P ＜ 0.05).Conclusion SLC5A8 gene transcription silence is the important events in the process of breast cancer occurrence and development.

Objective To investigate the clinical effects of two minimally invasive surgical treatments for billary acute pancretitis.Method In this study,63 patients with billary acute pancretitis were prospectively divided into two groups.Patients in group A received laparoscopic cholecystectomy (LC) and laparoscopic transcyctic common bile duct exploration (LTCBDE) within 72 hours of onset,group B underwent endoscopic nasobiliary drainage (ENBD).The two groups were evaluated by blood amylase and urine amylase,alanine aminotransferase,aspartate aminotransferase on postoperative day 1,3,5,local complication and the recurrence rate within 6 months.Result Blood amylase was lower in group A than that in group B (P =0.04) on postoperative day 1.There were no significant differences in amylase,aminotransferase of two groups on postoperative day 3,5 (all P ＞ 0.05).The incidences of local complications and pancreatic necrosis infection were 2.7％,7.7％ respectively(P =0.13) ; the incidences of pancreatic pseudocyst were 5.4％,7.7％ (P =0.42) ; the recurrence rate within 6 months were 2.7％ and 19.2％ respectively(P =0.006).Conclusions The clinical curative effects of early LC and LTCBDE or ENBD on billary acute pancretitis showed no significant differences,but the recurrence rate of acute pancretitis within 6 months revealed that early LC and LTCBDE may be more effective.