Objective:To investigate the influencing of portal vein embolization (PVE) and PVE combined with transcatheter arterial chemoembolization (TACE) on secondary hepatectomy and prognosis of patients with initially unresectable hepatocellular carcinoma (HCC).Methods:The retrospective cohort study was conducted. The clinicopathological data of 102 patients with initially unresectable HCC who were admitted to the Third Affiliated Hospital of Naval Medical University from October 26,2015 to December 31,2022 were collected. There were 82 males and 20 females, aged 52(range,25?73)years. Of 102 patients, 72 cases undergoing PVE combined with TACE were set as the PVE+TACE group, and 30 cases undergoing PVE were set as the PVE group. Observation indicators: (1) surgical resection rate of secondary hepatectomy and increase of future liver remnant (FLR); (2) situations of secondary hepatectomy; (3) follow-up. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data was conducted using the Mann-Whitney U test. The Kaplan-Meier method was used to calculate survival rate and draw survival curve, and Log-Rank test was used for survival analysis. Results:(1) Surgical resection rate of secondary hepatectomy and increase of FLR. The surgical resection rate of secondary hepatectomy in the PVE+TACE group and the PVE group were 72.2%(52/72) and 53.3%(16/30), respectively, showing no significant difference between the two groups ( χ2=3.400, P>0.05). The surgical waiting time, increasing volume of FLR, growth rate of FLR in the 52 patients of PVE+TACE group receiving secon-dary hepatectomy were 20(range, 14?140)days, 140(range, 62?424)mL, 9.8(range, 1.5?26.5)mL/day, respectively. The above indicators in the 16 patients of PVE group receiving secondary hepatectomy were 16(range, 12?35)days, 160(range, 95?408)mL, 10.5(range, 1.2?28.0)mL/day, respectively. There was no significant difference in the above indicators between the 52 patients of PVE+TACE group and the 16 patients of PVE group ( Z=1.830, 1.498, 1.266, P>0.05). (2) Situations of secondary hepatectomy. The operation time, rate of tumor necrosis (>90%, 60%?90%,<60%), cases with complications ≥ grade Ⅲa in the 52 patients of PVE+TACE group receiving secondary hepatectomy were 200(range, 125?420)minutes, 8, 4, 40, 28, respectively. The above indicators in the 16 patients of PVE group receiving secondary hepatectomy were 170(range, 105?320)minutes, 0, 0, 16, 4, respectively. There were significant differences in the above indicators between the 52 patients of PVE+TACE group and the 16 patients of PVE group ( Z=2.132, ?2.093, χ2=4.087, P<0.05). (3) Follow-up. Sixty-eight patients who completed the surgery were followed up for 40(range, 10?84)months. The 1-, 3-, 5-year recurrence free survival rate in the 52 patients of PVE+TACE group receiving secondary hepatectomy were 73.0%, 53.3%, 35.4%, respectively. The above indicators in the 16 patients of PVE group were 62.5%, 37.5%, 18.8%, respectively. There was a significant difference in the recurrence free survival rate between the 52 patients of PVE+TACE group and the 16 patients of PVE group ( χ2=4.035, P<0.05). The 1-, 3-, 5-year overall survival rate in the 52 patients of PVE+TACE group receiving secondary hepatectomy were 82.5%, 61.2%, 36.6%, respectively. The above indica-tors in the 16 patients of PVE group receiving secondary hepatectomy were 68.8%, 41.7%,20.8%, respectively. There was a significant difference in the overall survival rate between the 52 patients of PVE+TACE group and the 16 patients of PVE group ( χ2=4.767, P<0.05). Conclusion:Compared with PVE, PVE+TACE as stage Ⅰ surgery can increase the surgical resection rate of secondary hepatec-tomy and the recurrence free survival rate of patients with initially unresectable HCC, prolong the long-term survival time, but not influence the growth rate of FLR.

Objective:To evaluate the reliability and validity of the Chinese version of HEMO-FISS-QoL(HF-QoL) questionnaire (HF-QoL-C) in the Chinese population with hemorrhoids.Methods:From November 2021 to November 2022, a self-constructed general information questionnaire, HF-QoL-C, and the 36-item short form health survey (SF-36), Goligher classification, and Giordano severity of hemorrhoid symptom questionnaire (GSQ) were used to conduct a questionnaire survey on 760 hemorrhoid patients in the anorectal department of six hospitals. The data was analyzed for reliability and validity using SPSS 21.0 and AMOS 26.0 software.Results:The Cronbach's α coefficient of HF-QoL-C and its dimension ranged from 0.831 to 0.960, and the split coefficient was 0.832-0.915. Four common factors were extracted through principal component exploratory factor analysis. Confirmatory factor analysis indicated acceptable structural validity( χ2/ df=8.152, RSMEA=0.097, CFI=0.881, IFI=0.881, NFI=0.867). HF-QoL-C was correlated with SF36 and GSQ( r=-0.694, 0.501, both P<0.01). There were differences in the total score and dimensional scores of HF-QoL-C between surgical and drug treated patients, different grades of Goligher classification for hemorrhoidal disease, and different ranges of hemorrhoid prolapse (all P<0.001). No ceiling effect was found in the total score and the scores of each dimension(0.3%-2.0%). There was a floor effect in both psychological function and sexual activity dimensions (16.7%, 35.1%). Conclusion:HF-QoL-C has good reliability and validity, which can be used to measure the quality of life of Chinese hemorrhoid patients.

Objective To investigate the risk factors of pharyngocutaneous fistula(PCF)after total laryngectomy for hypopharyngeal cancer.Methods The clinical data of 89 hypopharyngeal cancer patients,who underwent total laryngectomy in The Affiliated Cancer Hospital of Nanjing Medical University from Jan.2009 to Dec.2019,were retrospectively analyzed.The patients were divided into PCF group and non-PCF group.The risk factors of PCF related to patient,disease,and treatment were analyzed.Results Among the 89 patients,20 cases had postoperative PCF and 69 had no PCF.The overall incidence of PCF was 22.5%.Univariate analysis showed that the proportions of patients with diabetes mellitus(P=0.031),preoperative chemoradiotherapy(P=0.021),preoperative hypoalbuminemia(P=0.008),postoperative hypoalbuminemia(P=0.002),and flap repair(P=0.034)in the PCF group were significantly higher than those in the non-PCF group.Multivariate logistic regression analysis showed that postoperative albumin level was an independent protective factor for PCF(odds ratio=0.174,95%confidence interval 0.048-0.626,P=0.007).Conclusion The hypopharyngeal cancer patients with diabetes mellitus,perioperative hypoalbuminemia,or preoperative chemoradiotherapy are more likely to develop PCF after total larynegctomy.

Objective To explore the application effect of volunteer service in the practical teaching of Traditional Chi-nese Pediatrics.Methods In 2023,80 undergraduate interns from the 2021 cohort at Yunnan University of Traditional Chinese Medicine,who were shadowing in the pediatrics department of a traditional Chinese medicine hospital in Yunnan,were randomly selected as research subjects.They were divided into an experimental group and a control group.The experimental group received teaching through a combination of volunteer service and traditional teaching methods,while the control group was taught using tra-ditional classroom methods.Results The experimental group scored significantly higher than the control group in clinical skills assessments,Mini-CEX scores,subject recognition evaluations,and teaching satisfaction,with statistically significant differences(P＜0.05).Conclusion The use of volunteer service in the practical teaching of Traditional Chinese Pediatrics is highly feasi-ble and can significantly enhance students'clinical practice abilities,stimulate their enthusiasm for learning,foster independent thinking,and improve their overall clinical competencies.

Objective:To investigate the current situation and influencing factors of clinical nurses'clinical decision-making ability,and provide a reference and evidence for improving and enhancing the correct clinical decision-making ability of clinical nurses.Methods:A total of 300 clinical nurses in Shaanxi Province were selected as the research subjects by using the convenience sampling method.The General Information Questionnaire,Clinical Decision-Making Scale,and Comprehensive Decision-Making Style Scale were used to conduct the investigation and study.The influencing factors of clinical nurses'clinical decision-making ability were analyzed by using single-factor analysis and multivariate linear regression.Results:The total score of clinical nurses'clinical decision-making ability was(163.85±13.78)points,reaching the high-level standard of clinical decision-making ability(146.68-200.00)points.The results of Spearman rank correlation analysis showed that there was a significant positive correlation between the total score and the score of each dimension of clinical decision-making ability and the score of rational decision-making style(P<0.05).The score of the dimension of searching for information or new information was only negatively correlated with the score of intuitive-impulsive decision-making style(P<0.05).Avoidant decision-making style was negatively correlated with the scores of seeking information or new information,clarifying goals and values,the total score of clinical decision-making ability,and the dimensions of finding alternative solutions(P<0.05).The results of multiple linear regression showed that rational decision-making style can positively affect clinical nurses'clinical decision-making ability,while avoidance decision-making style can negatively affect it.Conclusion:The clinical nurses'clinical decision-making ability has been maintained at a relatively constant high level,and it is greatly influenced by rational and avoidant decision-making styles.Medical managers need to organize targeted training activities and other measures to promote the construction of clinical nurses'rational decision-making style and minimize the influence of avoidant decision-making style,thus improving the clinical nurses'clinical decision-making ability.

Objective To explore the core acupoints and compatibility rules of acupuncture and moxibustion for epilepsy by using complex network method. Methods A prescription database was established through inclusion and exclusion criteria for searching literatures for databases from China National Knowledge Infrastructure, VIP, Wanfang, Web of Science, EMBASE, and Pubmed. SPSS Modeler software was used to analyze the frequency and correlation of acupoints, and Gephi0.10.1 software was used to establish a complex network model to explore the core acupoints and acupoint selection rules of prescriptions for epilepsy. Results Ultimately, 144 valid literatures were included, 199 prescriptions were extracted, involving 102 acupoints. Baihui acupoint had the highest frequency of use, specific acupoints were mainly Five-shu acupoint, the Eight Meridian Intersection acupoint, and the Back-shu acupoint. In selection of meridians, most acupoints were selected from governor meridian. Association rule analysis showed that Baihui-Taichong had the highest level of support and confidence. The analysis of complex network topology showed that 36 acupoints such as Baihui, Dazhui, Yaoqi and Fenglong were the core acupoints in the treatment of epilepsy by acupuncture and moxibustion. The analysis of acupoint communities revealed three major acupoint groups including governor meridian passing through treatment group, far and near matching acupoint group of the four limbs and head, and differentiation group of Zang-fu and body fluid for epilepsy treatment. Conclusion Acupoint compatibility of epilepsy by acupuncture and moxibustion should be mainly based on principle of the governor meridian combined with the differentiation of viscera and body fluid, and attention should be paid to distal-proximal point association.

Objective:To investigate the impact of group-based rehabilitation exercise on motor and non-movement symptoms of Parkinson's disease(PD).Methods:A total of 88 patients from out-patient and in-patient services at our hospital were randomly assigned to an early exercise group(E-EG), a late exercise group(L-EG), and a control group(CG)using a randomized delayed-start design.Patients in the E-EG carried out a rigorous, formal group exercise program, one hour per session, twice per week, for 18 months(May 2018-November 2019). Patients in the L-EG took part in the exercise program in the final 6-12 months of the study.We assessed outcomes using the Unified Parkinson's Disease Rating Scale(UPDRS), Parkinson's disease questionnaire-39(PDQ-39 Q), trail-making test part A & B, nine-hole peg test(9-HPT), 30 second sit to stand test(30s SST), 10 m walk test(10 m W), mini-balance evaluation systems test(Mini-BEST), Fullerton Advanced Balance(FAB)Scale and time up and go(TUG)test.Results:Compared with pre-exercise levels, patients with PD in the E-EG had lower performance in UPDRS(17.5±8.3 vs.20.0±8.6, t=-2.2, P=0.02)and lower performance in PDQ-39(27.2±2.1 vs.29.0±9.8, t=-2.6, P=0.001)after exercise.Moreover, compared with pre-exercise levels, patients with PD in the E-EG showed decreased post-exercise performance in trail-making test part B(114.2±25.5 vs.129.8±28.4, t=-2.3, P=0.02)and in 9-HPT(33.7±7.3 vs.39.6±9.3, t=-2.6, P=0.001). Conclusions:The practice of group-based rehabilitation exercise can improve movement abilities and quality of life in PD patients, especially if implemented early.Targeted rehabilitation exercise should be taken as part of the treatment strategy for PD patients as early as possible to deliver the best benefits.

Objective To evaluate the efficacy and safety of saffron freeze-dried effervescent tablets in the treatment of primary dysmenorrhea of qi stagnation and blood stasis,and to provide reference for its clinical application.Methods A prospective,randomized,double-blind,placebo parallel controlled clinical trial was designed.60 patients were randomly divided into treatment group and control group.After 3 months of elution,the patients were treated with saffron freeze-dried effervescent tablets and placebo respectively for 2 menstrual cycles and were followed up for 2 months.Results There was no significant change in the control group before and after treatment,while the symptoms in the treatment group were significantly relieved after treatment,which were significantly different from those before treatment,and no adverse reactions occurred in all subjects.Conclusion Saffron freeze-dried effervescent tablets can effectively treat primary dysmenorrhea of qi stagnation and blood stasis with good long-term efficacy and safety,which is worthy of further clinical study.

Objective:To study the clinical effects of portal vein embolization (PVE) with N-butyl cyanoacrylate copolymer (NBCA) and with gelatin sponge (GS) as embolization materials in patients with initially unresectable hepatocellular carcinoma (HCC).Methods:Clinical data of 90 patients with initial unresectable HCC who underwent PVE treatment at the Third Affiliated Hospital of Naval Medical University from November 2014 to April 2020 were included. There were 77 males and 13 females, aged 48 (25, 67) years old. Patients were divided into two groups according to the embolization materials selected in PVE: NBCA group ( n=60) and GS group ( n=30). Forty-eight and 18 patients finally underwent secondary hepatectomy in NBCA group (resectable NBCA group) and GS group (resectable GS group), respectively. Clinical data including future liver remnant (FLR) growth rate and secondary hepatectomy rate were analyzed. Survivals after hepatectomy was followed up by telephone, WeChat, and outpatient review. Results:The secondary hepatectomy rate in NBCA group was higher than that in GS group [80%(48/60) vs. 60%(18/30), P=0.043]. The waiting time from primary intervention to secondary hepatectomy in resectable NBCA group was 15 (7, 96) d, which was shorter than that in resectable GS group [40 (28, 118) d, P<0.001]. The FLR growth rate of resectable NBCA group was 9.03 (1.24, 29.64) ml/d, which was faster than that in resectable GS group [3.76 (0.08, 8.03) ml/d, P<0.001]. The recurrence-free survival (RFS) rates of patients in resectable NBCA group were 69.1%, 62.0% and 44.7% at 1, 2 and 3 years after surgery, and the overall survival (OS) rates were 76.4%, 69.5% and 59.6%, respectively. The RFS rates of patients in resectable GS group were 60.6%, 48.5% and 35.4% at 1, 2 and 3 years after surgery, and the OS rates were 66.7%, 60.6% and 42.4%, respectively. There were no significant differences in RFS and OS between two groups (all P>0.05). Conclusions:PVE with NBCA and GS as embolization material showed good efficacy in patients with initially unresectable HCC. The FLR growth rate and secondary hepatectomy rate of patients using NBCA were better than those of patients using GS.

Background: Subclinical hypothyroidism (SCH) is the most common thyroid dysfunction, and its relationship with blood pressure (BP) has been controversial. The aim of the study was to analyze the association between SCH and newly-diagnosed hypertension. Methods: Based on data from the Thyroid disease, Iodine nutrition and Diabetes Epidemiology (TIDE) study, 49,433 euthyroid individuals and 7,719 SCH patients aged ≥18 years were enrolled. Patients with a history of hypertension or thyroid disease were excluded. SCH was determined by manufacturer reference range. Overall hypertension and stage 1 and 2 hypertension were diagnosed according to the guidelines issued by the American College of Cardiology/American Heart Association in 2017. Results: The prevalence of overall hypertension (48.7%), including stage 1 (28.9%) and 2 (19.8%) hypertension, increased significantly in SCH patients compared with euthyroid subjects. With elevated serum thyroid stimulating hormone (TSH) level, the hypertension prevalence also increased significantly from the euthyroid to different SCH subgroups, which was more profound in females or subjects aged <65 years. The age- and sex-specific regression analysis further demonstrated the same trends in the general population and in the 1:1 propensity matched population. Similarly, several BP components (i.e., systolic, diastolic, and mean arterial BP) were positively associated with TSH elevation, and regression analysis also confirmed that all BP components were closely related with SCH in female subjects aged <65 years. Conclusion The prevalence of hypertension increases for patients with SCH. SCH tends to be associated with hypertension and BP components in females younger than 65 years.