Mianyang Third People's Hospital

Pancreatic exocrine insufficiency (PEI), presenting as bloating or diarrhea, affects 26%-100% of patients after gastrectomy, delaying recovery and impairing quality of life. Pancreatic enzyme replacement therapy (PERT) is the standard PEI management, yet its efficacy after gastric cancer surgery remains controversial. This study evaluates PERT's effectiveness in alleviating postoperative gastrointestinal symptoms. In this multicenter randomized controlled trial, 204 patients undergoing radical gastrectomy will be randomized 1:1 to PERT or control. The PERT group will receive Pancreatin Enteric-coated Capsules (containing 450mg pancrelipase microgranules) three times daily with meals for 1month post-discharge. The primary outcome is the incidence of gastrointestinal symptoms at 1month post-surgery, assessed using the MD Anderson Symptom Inventory Gastrointestinal Cancer Module (MDASI-GI). Secondary outcomes include nutritional status and treatment compliance. This protocol establishes a framework for definitively evaluating PERT in gastric cancer patients. Results will inform evidence-based PEI management, with significant implications for survivorship care. By integrating patient-reported outcomes and nutritional metrics, we aim to validate a patient-centered strategy optimizing functional recovery after curative resection. This study was registered with the Chinese Clinical Trial Registry (ChiCTR; registry number: ChiCTR2500102557). Date of registration: 16 May 2025.

ObjectivesPost-COVID-19 respiratory infection patterns require updated epidemiological data. To investigate the prevalence and infection patterns of upper respiratory tract infections (URTIs), a survey was conducted to assess the presence of influenza A (IFV A), influenza B (IFV B), respiratory syncytial virus (RSV), human rhinovirus (HRV), adenovirus (Adv), and SARS-CoV-2 among outpatients diagnosed with URTIs.DesignA community-based cross-sectional study.SettingThree cities in Sichuan, China.Participants1174 outpatients diagnosed with URTIs from December 2023 to February 2024.MethodsOropharyngeal swabs were collected using sterile flocked swabs, preserved at 4°C and analysed within 24 hours. Viral nucleic acid was extracted automatically and detected via multiplex PCR-melting curve analysis.ResultsResults showed in positive detection rates varied significantly by age (p<0.001), peaking in children (77.42%), followed by adolescents (73.23%), adults (63.59%) and older adults (57.58%). IFV B and A predominated, followed by HRV, Adv, RSV and SARS-CoV-2. 12 co-infection types were identified, with HRV/Adv and IFV B/HRV most prevalent. In children and adolescents, co-infections were significantly more common, with predominant types including HRV/Adv, HRV/RSV and RSV/IFV B.ConclusionsThis study reveals persistent influenza dominance and age-stratified co-infection risks and provides critical baseline data for optimising respiratory infectious disease control in the post-pandemic era.

Small cell lung cancer (SCLC) with liver metastases (LM), represents a highly aggressive clinical challenge characterized by significant morbidity, poor durable responses to chemoimmunotherapy, and limited therapeutic options. While most research has focused on tumor-intrinsic driver mutations and the local liver microenvironment, the remote influence of the gut microbiota on LM-SCLC pathogenesis remains a largely unexplored area. Emerging evidence from other cancer types suggests that the gut microbiota composition and its derived metabolites can modulate systemic immune tolerance, influence hepatic immune surveillance, and affect the efficacy and toxicity of anticancer therapies. This review synthesizes current knowledge on the gut–liver axis in cancer metastasis, with a specific focus on its pathogenesis. We discuss the molecular and immunological pathways through which gut microbial dysbiosis may promote an immunosuppressive liver microenvironment, facilitate the formation of a pro-metastatic niche, and impair anti-tumor responses. Specifically, we detail how translocated microbial products, such as lipopolysaccharide (LPS), and pro-tumorigenic secondary bile acids (SBAs) activate key hepatic immune cells (Kupffer cells, KCs) and stromal cells (hepatic stellate cells, HSCs). This activation modulates key signaling cascades and promotes the survival and outgrowth of circulating SCLC cells. Furthermore, we explore promising microbiota-based therapeutic strategies—including probiotics, prebiotics, fecal microbiota transplantation (FMT), and next-generation microbial therapeutics (NGMTs)—as novel approaches to augment standard-of-care treatments. A deeper understanding of the interplay between the gut microbiota and LM-SCLC is essential for opening new avenues for personalized combination therapies and improving outcomes for this high-risk patient population.

Abstract Objective To analyze the current status and influencing factors of occupational calling among psychiatric nurses, construct a Bayesian network model, and conduct an in-depth analysis of the key influencing factors and the relationships between them. Methods In June 2024, psychiatric nurses from a tertiary Grade A hospital in Mianyang City were selected by convenience sampling. A questionnaire survey was conducted using the General Information Questionnaire, Occupational Calling Scale, Job Involvement Scale, Professional Identity Scale, and Work-Family Conflict Scale. LASSO regression was used to screen the influencing factors related to the occupational calling of psychiatric nurses, and Bayesian network was employed to analyze the interactions between these influencing factors. Results A total of 216 subjects were included in this study. The scores were as follows: occupational calling (3.72 ± 0.65), job involvement (4.50 ± 1.36), professional identity (5.48 ± 0.74), and work-family conflict (2.61 ± 0.67). LASSO regression results showed that educational level ( β =-0.19, P &lt; 0.01), position ( β = 0.08, P &lt; 0.01), professional title ( β = 0.01, P &lt; 0.01), personnel status ( β = 0.06, P &lt; 0.01), professional identity ( β = 0.20, P &lt; 0.01), work-family conflict ( β =-0.19, P &lt; 0.01), and job involvement ( β = 0.13, p &lt; 0.01) were all correlated with occupational calling, with professional identity showing the highest degree of correlation. Position, professional title, work-family conflict, and job involvement directly affected professional identity, while educational level and personnel status indirectly influenced occupational calling. Conclusion Education,employment type, post, professional title, job involvement, professional identity, and work-family conflict are the influencing factors of occupational calling among psychiatric nurses. Professional identity has the closest association with occupational calling. Assisting nursing staff in self-improvement and establishing a management system centered on professional competence and vocational value is conducive to improving the level of occupational calling among psychiatric nurses.

In recent years, resting-state functional magnetic resonance imaging (rs-fMRI) has been widely used in the study of Parkinson's disease (PD), but the findings have not yet reached consensus. Besides, no studies have been conducted to standardize meta-analyses by combining the amplitude of low-frequency fluctuation (ALFF), fractional amplitude of low-frequency fluctuation (fALFF), and regional homogeneity (ReHo) functional indicators of PD. A whole-brain voxel-wise meta-analysis was performed on resting-state functional imaging studies that explored differences in spontaneous functional brain activity between individuals with PD and healthy controls (HCs) using the Seed-based d Mapping with Permutation of Subject Images (SDM-PSI) software. A total of 59 independent functional imaging studies (88 datasets) with 2591 individuals with PD and 1804 HCs were included. The results of the main meta-analysis revealed decreased resting-state regional functional activity in the left lenticular nucleus, the putamen, and the left supplementary motor area in PD patients compared to HCs, and no brain regions with significantly increased functional activity were identified. In the subsequent jackknife sensitivity analyses, these results showed high robustness and no significant heterogeneity or publication bias was observed. This functional meta-analysis not only revealed robust and consistent brain regions with altered spontaneous functional activity in PD, but also helped to deepen our understanding of the complex neuropathological mechanisms of PD.

Accurate dose calculation is essential for securing the therapeutic benefit and safety of carbon ion radiotherapy. However, the uncertainty associated with tissue parameter estimation methods for Monte Carlo-based dose calculation has not been systematically evaluated, potentially limiting the reliability of quality assurance in clinical practice. To support more accurate treatment planning and quality assurance for carbon ion radiotherapy, this study aims to systematically assess how upstream uncertainties in tissue parameter estimation affect Monte Carlo-based carbon ion dose calculations. By comparing three elemental decomposition approaches, their impact on the consistency and reliability of dose distributions were quantitatively evaluated. Relevant sources of uncertainties in physical density and elemental composition were analyzed and propagated based on three methods: single-energy CT (SECT), parameterized dual-energy CT (PA-DECT), and machine learning-based DECT (ML-DECT). For validation, the ICRP 110 phantom was perturbed accordingly, and dose distributions were simulated using FLUKA with 10 samples for each method. Both physical and biological doses were evaluated. The voxel-wise uncertainty, gamma passing rate and range uncertainty were examined. The ML-DECT method consistently yielded the lowest uncertainties across all tissue parameters, reducing the uncertainties for C, N, and O density by up to 77.4% compared to SECT. In dose simulations, ML-DECT achieved lower average relative uncertainties (∼5% physical, ∼7%-9% biological), a higher gamma passing rate (97.96±0.28%), and reduced range uncertainty (0.5%) compared to other methods. By more accurately modeling the relationship between CT numbers and tissue parameters, ML-DECT substantially reduces uncertainty in both input estimation and subsequent dose calculation. These findings support its integration into Monte Carlo-based carbon ion treatment planning workflows, contributing to more quantitative and uncertainty-aware quality assurance.

To investigate the value of transitional phase characteristics on Sonazoid contrast-enhanced ultrasound (S-CEUS) in the differential diagnosis of common focal liver lesions (FLLs). This prospective multicenter study enrolled 122 participants with FLLs from 8 medical centers between December 2023 and March 2025. The study comprised 43 cases of hepatic hemangioma (HH), 35 cases of hepatocellular carcinoma (HCC), and 44 cases of liver metastases (LM). All participants underwent standardized S-CEUS examinations. The enhancement characteristics and washout patterns during the transitional phase were analyzed for all participants. Significant differences were observed among the three types of lesions in terms of early arterial enhancement patterns, time to start of washout, and the degree of enhancement during the transitional phase (P < .01). The optimal diagnostic efficacy was achieved with the following criteria: washout start at 3.5 min for diagnosing HH (AUC = 0.974); mild hypoenhancement observed in 3 and 4 min for diagnosing HCC (AUC = 0.880 and 0.879); and marked hypoenhancement observed between 4 and 6 min for diagnosing LM (AUC = 0.911-0.916). The dynamic characteristics of the transitional phase in S-CEUS can effectively differentiate common FLLs, providing a valuable basis for precise clinical diagnosis.

BackgroundThe onset of COVID-19 and subsequent restrictive measures have impacted various infectious diseases, including hepatitis B virus (HBV). This study explored the epidemiological characteristics of HBV infection in Chinese adults before, during the pandemic, and after the easing of restrictive measures.MethodsThis population-based cohort study used the data from 23,316 adult patients in the southwest of China who had HBV DNA tests from 1 January 2018 to 31 December 2023. HBV DNA was detected in patient serum using real-time fluorescent quantitative PCR. The positive rate of HBV detection was adjusted by age groups, sex, patient types, and seasons, stratified by the stages of the COVID-19 pandemic.ResultsOur analysis revealed significant variations in HBV DNA test positivity rates, primarily influenced by age and the pandemic stages. Positivity rates were highest in the 18–25 age group at 0.50 and decreased with advancing age. Males under 35 were at higher risk. Inpatients had the highest positivity rate at 0.42, with seasonal fluctuations peaking in winter. The pandemic stages significantly affected positivity rates, especially in the 36–45 and 56–65 age groups.ConclusionThe findings highlight a complex interplay between pandemic conditions and observed positivity rates. The increase likely stemmed from multiple factors, including shifted testing focus, altered healthcare-seeking behavior, and potential viral reactivation. The COVID-19 response offers insights for optimizing future viral hepatitis control strategies during public health emergencies. Future research should expand demographic and geographic scope and investigate behavioral/social determinants to elucidate underlying mechanisms and guide targeted interventions.

Glioblastoma is the most aggressive primary malignancy of the central nervous system. Emerging evidence indicates that hypoxia-induced ferroptosis resistance is a key factor in therapeutic resistance and solid tumor growth. Here, we reveal the PRSS23–NCAPD3/YY1/MBOAT2 signaling axis as a critical mediator of noncanonical ferroptosis resistance in glioblastoma. Machine learning was applied to the analysis of TCGA/CCGA datasets, and PRSS23 was identified as a critical glioblastoma-associated protease, with elevated expression in hypoxic tumor regions correlating with poor patient prognosis. Functional assays confirmed the impact of PRSS23 on cell proliferation, while co-immunoprecipitation and subcellular localization studies demonstrated the nuclear translocation of PRSS23 and its interaction with the chromatin remodeling factor NCAPD3. Multi-omics integration (ATAC-seq, RNA-seq) revealed that hypoxia-induced PRSS23–NCAPD3 cleavage promoted chromatin accessibility, driving transcriptional activation of the YY1-MBOAT2 axis. Lipidomic analysis further linked this pathway to reduced membrane polyunsaturated fatty acid/monounsaturated fatty acid ratios, establishing a mechanism of atypical ferroptosis resistance. In murine models, pharmacological inhibition of PRSS23 via SPINK1 and disruption of the PRSS23–NCAPD3 interaction using the Pa-125 TAT peptide enhanced ferroptosis sensitivity, suppressed tumor growth, and prolonged survival. Collectively, these results highlight the critical role of PRSS23 in enhancing nonclassical ferroptosis resistance in hypoxia via the NCAPD3/YY1/MBOAT2 axis, which drives glioblastoma progression. SPINK1 and the Pa-125 TAT peptide may serve as treatment reagents to disrupt this mechanism.