Objective:To systematically review the related factors of depressive symptoms among men who have sex with men(MSM)in China.Methods:CNKI,Wanfang Data,VIP,CBM,EMbase,Pubmed,CINAHL,Web of Science and the Cochrane Library were searched from inception to February 17,2023.After literature screening and data extraction,two researchers independently assessed the quality of included studies according to the Agency for Healthcare Research and Quality.Results:A total of 21 articles with 11 822 participants were includ-ed.The results of meta-analysis showed that month income ≥3 000 yuan(OR=0.59),college degree or above(OR=0.59)and high self-esteem(OR=0.83)were protective factors,sexual role as the recipient(OR=1.68),dual sexual role(OR=1.41),multiple sexual partners(OR=1.65),sexual violence experience(OR=3.44),self-rated poor health status(OR=3.93),HIV/AIDS related discrimination(OR=1.13),HIV/AIDS related stress(OR=1.11)and suicidal tendency(OR=2.86)were risk factors for depressive symptoms.Conclusion:There are many related factors to the depressive symptoms of MSM.It is necessary to carry out early intervention on the basis of personalized assessment to reduce the occurrence of depressive symptoms among MSM.

Objective To analyze the status of the bacteria in the operative area of transnasal skull base surgery and its correlation with postoperative intracranial infection.Methods The procedure of transnasal skull base surgery was divided into three stages:nasal passage preparation(stage 1),tumor resection(stage 2),and skull base reconstruction(stage 3).Bacterial sampling was taken from the mucosa of the anterior wall of sphenoid sinus or clival recess of sellar floor at the beginning of each stage;and the positive rate of bacterial culture in different stages of operation and its correlation with postoperative intracranial infection were analyzed.Results A total of 105 patients were enrolled in this study,and 315 samples were taken.The average time point of sampling in the three stages was 20.3,45.1 and 131.3 min after the beginning of operation,respectively.The positive results were 9 cases(2.9％)in the stage 1,8 cases(2.5％)in the stage 2,and 23 cases(7.3％)in the stage 3,which were 24 cases of Staphylococcus epidermidis,7 cases of Staphylococcus aureus,3 cases of hemolytic streptococcus,2 cases of Klebsiella pneumonia,and 4 cases of Escherichia coli.There was no significant difference in the positive cases between stage 1 and stage 2(P=0.955),but there were significant differences between stage 1 or 2 and stage 3(P=0.013;P=0.007).There were 36(11.4％)patients with at least one positive result in the three stages,17(16.2％)with cerebrospinal fluid leakage,and 12(11.4％)with intracranial infection.The risk of intracranial infection was 3.1 times higher in patients with positive bacterial culture than patients with negative bacterial culture(OR=3.1,95％CI:0.9-10.6),which was not statistically significant;patients with CSF leakage were 61.4 times higher than those without CSF leakage(OR=61.4,95％CI:11.2-337.1),which was statistically significant(P＜0.001).The consistency rate of bacteria in nasal cavity and postoperative cerebrospinal fluid culture was 57.1％.Conclusion The positive rate of bacterial culture in the operative area of transnasal skull base surgery increases significantly with the extension of operation time,which is a potential risk index of postoperative intracranial infection.

Objective To systematically review the incidence and influencing factors of refeeding syndrome(RFS)in critically ill patients,and provide references for early identification of RFS and formulation of preventive measures.Methods Computerized searches were conducted for studies on RFS in critically ill patients in the databases of China National Knowledge Infrastructure(CNKI),Wanfang,VIP,CBM,PubMed,Embase,Web of Science,CINAHL,Cochrane Library from inception to May 29th,2024.Data analysis was performed using Stata 16.0 software.Results A total of 29 articles with 5 720 participants were included.The Meta-analysis showed that the incidence of RFS in critically ill patients was 33.68％.The subgroup analysis showed that the incidence of RFS in critically ill patients was higher in studies conducted in 2020 or later(38.22％),in the Americas(36.39％),and with only electrolyte changes as the diagnostic basis(37.51％).Risk factors for RFS in critically ill patients included higher acute physiological and chronic health evaluation Ⅱ scores(OR=1.41),higher sequential organ failure assessment scores(OR=1.29),initiation of feeding within 48 h of ICU admission(OR=3.36),age ≥60 years(OR＝2.82),diabetes mellitus(OR=3.53),pre-albumin concentration＜150 g/L(OR=5.53),albumin concentration＜30 g/L(OR=3.26),caloric intake＞25％standard calories(OR=2.86),enteral solution temperature of 36～38 ℃(OR=2.32),feeding rate＞50 ml/h(OR=3.76),fasting time ≥2 d before feeding(OR=2.46),history of alcoholism(OR=2.64).Conclusion The incidence of RFS in critically ill patients is high and there are many influencing factors.Nurses should improve their awareness and attention to RFS,accurately identify high-risk groups and risk factors,and adopt a multidisciplinary collaborative model to develop whole-course,detailed and personalized intervention measures to prevent RFS.

Objective To systematically analyze influencing factors of migration stress of patients'families transferred out of intensive care unit(ICU)in China,and provide evidence-based guidance for alleviating migration stress level of families of transferred patients.Methods Computer searches were conducted on China National Knowledge Infrastructure,Wanfang Data Knowledge Service Platform,VIP,China Biomedical Literature Database,Web of Science,PubMed,the Cochrane Library and Embase for observational studies such as cohort studies,case-control studies and cross-sectional studies on factors influencing migration stress among family members of ICU patients.Search deadline was from database establishment to October 2023.Literature screening,quality assessment and data extraction were conducted independently by two researchers in accordance with the inclusion and exclusion criteria.RevMan5.4 software was used to conduct a Meta-analysis of the data results.Results Fifteen studies were finally included,with a total sample size of 2558 and 12 influencing factors were extracted.Fifteen articles were divided into positive scoring group(higher scores,higher levels of migration stress,nine articles)and negative scoring group(higher scores,lower levels of migration stress,six articles)based on instruments used to measure outcome indicators.When analyzing each group,only factors mentioned in the group more than twice were included in Meta analysis.Meta analysis showed that within positive scoring group,family member education level,family member gender,patient awareness,ICU treatment time and family member uncertainty about the disease were factors affecting migration stress of ICU transfer patients'families(P<0.05);In reverse calculation group,educational level of family member,gender of family member,age of patient and ICU treatment time were influencing factors of migration stress of family members of ICU transfer patients(P<0.05).Sensitivity analysis result showed that result of each factor was relatively stable.Conclusion Educational level of family member,gender of family member,age of patient,ICU treatment time,uncertainty of family member's illness are influencing factors of migration stress of family members of patients transferred out of ICU in China.Influence of family member's religious beliefs and patient's consciousness needs further demonstration.

Purpose To evaluate the value of shear wave elastic imaging of liver and spleen in predicting high risk esophageal and gastric varices in cirrhosis.Materials and Methods Sixty-four patients with cirrhosis in the First Hospital of Lanzhou University from November 2019 to April 2022 were enrolled prospectively,and underwent gastroscopy,elastography and serological examination.According to gastroscopy,patients were divided into high-risk varices(HRV,30 cases)and non-HRV group(34 cases),the differences of each clinical index and shear wave elastic imaging parameter between the groups were compared.The diagnostic efficacy of liver and spleen stiffness measurement for HRV was analyzed.And the diagnostic models were established for exploring the diagnostic effectiveness of different models with respect to excluding HRV in compensated liver cirrhosis.Results There were significant differences in platelet[(74±24)×109/L vs.(124±50)×109/L],liver stiffness[(16.1±5.6)kPa vs.(13.6±5.5)kPa]and spleen stiffness[(41.7±8.9)kPa vs.(28.1±8.6)kPa]between HRV and non-HRV groups(t/Z/χ2=5.136,-1.832,-6.206,all P<0.05).The areas under the curve of liver stiffness and spleen stiffness for predicting HRV were 0.660 and 0.858,respectively.The Baveno Ⅵ combined with the spleen stiffness model had the best performance(30.0％)for excluding HRV.Conclusion The measurement of liver and spleen stiffness by shear wave elastography has great diagnostic value for predicting HRV in cirrhosis,and spleen stiffness is better than liver stiffness.

Objective To analyze the influencing factors of disaster resilience in medical rescue workers,to construct a prediction model for the low-level risk of disaster resilience in medical rescue workers,and to verify the predictive effect of the model.Methods Using the convenience sampling method and the snowball method,1 037 medical rescue workers who participated in disaster rescue in 18 provinces(autonomous regions and municipalities)were selected as the participants from May to July 2022.Online questionnaire surveys were conducted using general information questionnaires,disaster resilience measuring tools for healthcare rescuers,the Mindful Attention Awareness Scale,the Simple Coping Style Questionnaire and the Depression-Anxiety-Stress Scale.Univariate and multivariate logistic regression analyses were used to determine the independent influencing factors for the low level of disaster resilience of medical rescue workers.A risk prediction model was constructed,and a nomogram chart was drawn.The model's effectiveness was evaluated using the receiver operating characteristic curve(ROC)and calibration curve.The Bootstrap method was applied for internal validation.Results The logistic regression analysis showed that per capita monthly income of households,whether to participate in on-site disaster rescue,positive coping,mindfulness level,and adequacy of rescue supplies were independent influencing factors for the disaster resilience of medical rescue workers(P＜0.05).The predictive formula for the low-level risk of disaster resilience in medical rescue workers was established as follows:Logit(P)=8.741-0.381 x per capita monthly income of households-0.891 x whether to participate in on-site disaster rescue-2.544 x positive coping-0.020 x mindfulness level-0.222 x adequacy of rescue supplies.The area under the ROC curve was 0.823,and the optimal critical value was 0.353.The sensitivity and specificity were 79.12％and 71.43％,respectively.The Hosmer-Lemeshow test showed that x2=12.250(P=0.140),and the predicted curve fitted well with the ideal curve.The external validation showed that the sensitivity and specificity of the model were 75.00％and 66.39％,respectively,and the overall accuracy was 69.95％.Conclusion The prediction model in this study has sound predictive effects and can provide references and guidance for managers to select,recruit,and train medical rescue workers.

Retinopathy of prematurity (ROP) is a major cause of vision loss and blindness among premature infants. Timely screening, diagnosis, and intervention can effectively prevent the deterioration of ROP. However, there are several challenges in ROP diagnosis globally, including high subjectivity, low screening efficiency, regional disparities in screening coverage, and severe shortage of pediatric ophthalmologists. The application of artificial intelligence (AI) as an assistive tool for diagnosis or an automated method for ROP diagnosis can improve the efficiency and objectivity of ROP diagnosis, expand screening coverage, and enable automated screening and quantified diagnostic results. In the global environment that emphasizes the development and application of medical imaging AI, developing more accurate diagnostic networks, exploring more effective AI-assisted diagnosis methods, and enhancing the interpretability of AI-assisted diagnosis, can accelerate the improvement of AI policies of ROP and the implementation of AI products, promoting the development of ROP diagnosis and treatment.

Primary sclerosing cholangitis （PSC） is an immune-mediated chronic cholestatic liver disease and can progress to end-stage liver diseases such as liver cirrhosis and liver failure， and there are still no effective treatment methods at present. Studies have found that T lymphocytes are closely associated with the development and progression of PSC. This article reviews the role of T lymphocytes in PSC， so as to provide new ideas for research on the pathogenesis of PSC and the clinical diagnosis and treatment of PSC.

Objective To investigate the value of Charlson comorbidity index (CCI) in predicting the short- and long-term risks of death in patients with acute-on-chronic liver failure (ACLF). Methods A total of 317 patients with ACLF who attended The First Hospital of Lanzhou University from December 1, 2016 to December 1, 2021 were enrolled, and according to their prognosis, they were divided into death group with 169 patients and survival group with 148 patients. The two groups were analyzed in terms of clinical data and follow-up data. The group t -test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. The univariate and multivariate Cox proportional-hazards regression model analyses were used to investigate the influencing factors for the prognosis of ACLF patients. The Kaplan-Meier method was used to plot survival curves, and the Log-rank test was used for comparison of survival time between patients with different CCI scores. The receiver operating characteristic (ROC) curve was used to evaluate the performance of CCI and other indices in assessing the prognosis of ACLF patients. Results Among the 317 patients, there were 225 (71.0%) male patients. There were significant differences between the death group and the survival group in age, hemoglobin, white blood cell count, total bilirubin, albumin, Model for End-Stage Liver Disease (MELD) score, prothrombin time activity, CCI, age-adjusted Charlson co-morbidity index (ACCI), and follow-up time (all P < 0.05). The multivariate Cox regression analysis showed that the CCI (hazard ratio [ HR ]=1.351, 95% confidence interval [ CI ]: 1.112-1.641, P =0.002), ACCI ( HR =1.200, 95% CI : 1.011-1.423, P =0.037), and MELD score ( HR =1.076, 95% CI : 1.054-1.099, P < 0.001) were independent risk factors for the prognosis of ACLF patients. Based on CCI score, the patients were divided into CCI ≤4 group with 167 patients, CCI=5 group with 64 patients, and CCI ≥6 group with 86 patients, with a 3-year mortality rate of 26.5%, 83.2%, and 96.9%, respectively, and there was a significant difference in survival time between any two groups after 3 years of follow-up and at the time of follow-up till September 2022 (all P < 0.001). CCI, ACCI, and MELD scores had an area under the ROC curve of 0.845, 0.811, and 0.790, respectively, in predicting the prognosis of ACLF patients. Conclusion As commonly used comorbidity assessment indices, CCI and ACCI scores have certain value in evaluating the short- and long-term prognosis of ACLF patients.

Objective:To carry out a scoping review on the application of network intervention in home palliative care for children with life limiting diseases.Methods:Based on the scoping review methods of Arksey and O'Malley, relevant researches were searched on Web of Science, PubMed, CINAHL, Embase, China National Knowledge Infrastructure, WanFang Data, VIP, and China Biomedical Medline Disc. The search period was from database establishment to October 21, 2022. The included articles were analyzed and summarized.Results:A total of 9 articles were included. The elements of network intervention included providing information and guidance on care skills, disease assessment and monitoring, symptom management and decision support, communication with professionals, and psychological support. The main types of outcome indicators were intervention feasibility, effectiveness, and cost-effectiveness.Conclusions:The application of network intervention in home palliative care for children with life limiting diseases is cost-effective and feasible, and its effectiveness needs further confirmation. It is necessary to fully consider the needs of children and their caregivers, and develop a localized network intervention model that is suitable for China's national conditions, in order to provide precise, efficient, and high-quality home palliative care services.