Tianjin Fourth Central Hospital

Abstract Objective: To explore the impact of a multidisciplinary intervention model guided by the Enhanced Recovery After Surgery (ERAS) concept on the prognosis of frail elderly patients undergoing gastrectomy and to provide clinical evidence for optimizing perioperative management strategies. Methods: A prospective cohort study design was adopted. A total of 186 frail elderly patients who underwent elective gastrectomy in our hospital from January 2023 to June 2025 were selected and divided into a control group (94 cases) and a conventional group (92 cases) based on the intervention method. The conventional group received the traditional perioperative management model, while the control group was subjected to a multidisciplinary collaborative ERAS intervention plan involving the surgical department, anesthesiology, nutrition, rehabilitation, geriatrics, and the nursing team. The postoperative complication rate, hospital stay, ICU stay, postoperative functional recovery, and 30-day readmission rate were compared between the two groups, and the clinical value of the multidisciplinary ERAS intervention was analyzed. Results: The total postoperative complication rate (χ² = 7.523, P = 0.006), postoperative hospital stay, and ICU stay of the control group were significantly shorter than those of the conventional group (P < 0.001). At 7 days postoperatively, the 6-minute walk test distance and the Mini-Mental State Examination scores of the control group were significantly better than those of the conventional group (all P < 0.001). The 30-day readmission rate of the control group was lower than that of the conventional group (χ² = 4.572, P = 0.032). Conclusion: Implementing a multidisciplinary intervention based on the ERAS concept for frail elderly patients undergoing gastrectomy can significantly reduce the postoperative complication rate, shorten hospital stay, promote physical and cognitive function recovery, and improve clinical prognosis, which has important clinical promotion value.

Abstract Background Self-management behaviour plays a crucial role in controlling blood pressure in patients with hypertension. Most of studies on self-management behavior are based on the scores of questionnaire or the dimension which limits a comprehensive understanding of the full spectrum of hypertension self-management behavior. This study aimed to investigate the network structure of self-management of elderly patients with hypertension, and explore the correlation between self-management behaviour, knowledge level, and social support. Methods The survey was conducted in Tianjin, China, from March to May 2023. Network analysis was employed to examine the network structure of hypertension self-management behavior, and flow network analysis was used to assess the relationships between self-management behavior, knowledge level, and social support. Results A total of 804 patients were enrolled. The three core behaviors of elderly patients with hypertension were: physical exercise, take medication prescribed by doctor, and balanced nutrition. Flow network analysis indicated that take medication as they feel from knowledge had the highest negative correlation with self-management behavior, while support and care of family members from social support had the highest positive correlation with self-management behaviour. Conclusion Regular exercise, adherence to prescribed medication schedules, and balanced nutrition were identified as core components of hypertension self-management. Enhancing patients’ knowledge about proper medication use and promoting support and care from family members will help improve self-management behavior in elderly patients with hypertensive.

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To provide a scoping review of studies on factors affecting smoking cessation in patients with chronic obstructive pulmonary disease (COPD), so as to provide a basis for healthcare professionals to intervene early in the process of cessation of smoking in patients with COPD, and to formulate personalized interventions for smoking cessation. Arksey and O’Malley’s scoping review methodology as a framework, searched databases including CNKI, Wanfang Data, VIP, China Biomedical Database, PubMed, Web of Science, Embase, ProQuest, CINAHL, and Cochrane Library to collect literature on factors influencing smoking cessation among COPD patients. The literature was screened, data extracted, and summarized accordingly. A total of 28 papers were included. The socio-demographic related factors affecting smoking cessation in patients with COPD were age, educational level, residence, marital status, occupational status, economic status, race, and sex; tobacco related factors included smoking index, smoking duration (years), cumulative smoking (packs/year), smoking intensity (packs/day), and tobacco addiction; disease related factors included mMRC score, GOLD level, severity of airflow restrictions, symptom, activity limitation due to lung problems, history of deterioration in outpatient care, receipt of COPD medication, receipt of lung CT, receipt of pulmonary function tests, receipt of surgery, and comorbid comorbidities; psychologically related factors included mental health status, quit smoking health beliefs, smoking cessation self-efficacy, motivation to quit smoking, stress, and adverse emotions; environmental/Interpersonal network related factors-included environmental impacts, social support, family support, tobacco control policies, and satisfaction with cessation care; and behavior related factors included alcohol consumption, coffee consumption, eating, physical activity, and have a hobby. Healthcare professionals should avoid critical education of COPD patients in the process of smoking cessation management, pay attention to the adverse effects of medication side effects on patients, emphasize the improvement of patients’ health beliefs and self-efficacy in smoking cessation, and help patients to establish a correct cognition of smoking cessation.

Inflammatory myofibroblastic tumor (IMT) is a rare tumor originating from mesenchymal tissue. Epithelioid inflammatory myofibroblastic sarcoma (EIMS) represents a rare and particularly aggressive variant, associated with a worse prognosis. Almost all EIMS cases exhibits activating anaplastic lymphoma kinase (ALK) gene rearrangements, which suggests that EIMS patients may potentially benefit from treatment with ALK tyrosine kinase inhibitors (TKIs). We presented a case involving a 34-year-old woman who was diagnosed with mediastinal EIMS and had a rare echinoderm microtubule-associated protein-like 4 (EML4) -ALK fusion. Following 15 months of neoadjuvant lorlatinib treatment, the patient underwent a complete surgical resection, resulting in a pathological complete response. Given the heightened risk of postoperative recurrence associated with EIMS, the patient's treatment plan included ongoing adjuvant therapy with lorlatinib. As of the present moment, the patient has achieved an overall survival of over 2years with no observed tumor recurrence. Consequently, the case offers valuable clinical evidence supporting the potential benefits of neoadjuvant lorlatinib treatment for ALK-positive locally mediastinal EIMS patients, with a demonstrated tolerable safety profile.

Objective: To investigate the influence of circ_BACH2 on the malignant biological behavior of papillary thyroid cancer and its molecular mechanism. Methods: Cancer tissues and paracancer tissues of 51 patients with papillary thyroid carcinoma from the Fourth Central Hospital of Tianjin between 2017 and 2019 were collected. Reverse transcription-quantitative real-time polymerase chain reaction (RT-qPCR) was used to detect the expressions of circ_BACH2, miR-370-3p and G protein coupled receptor kinase interacting factor 1 (GIT1) mRNA in tissues and cells; flow cytometry to detect cell apoptosis and cell cycle; plate clone formation experiment to detect the number of cell clones; cell counting kit 8 (CCK-8) to detect cell proliferation; Transwell array to detect cell migration and invasion; western blot to detect protein expressions; dual luciferase report experiment to detect the targeting relationship between circ_BACH2, miR-370-3p and GIT1; the nude mouse tumor formation experiment to detect the effect of circ_BACH2 on tumors in mice. Results: Compared with adjacent tissues, the expressions of circ_BACH2 and GIT1 in papillary thyroid cancer tissues was increased, while the expression of miR-370-3p was decreased. Compared with Nthy-ori3-1 cells, the expressions of circ_BACH2 in papillary thyroid cancer cells TPC-1 and SW579 were increased, the mRNA and protein levels of GIT1 were increased, miR-370-3p expression was decreased. The expression level of GIT1 mRNA was negatively correlated with that of miR-370-3p (r=-0.634), and the expression level of circ_BACH2 was positively correlated with that of GIT1 (r=0.635). The expression level of circ_BACH2 was negatively correlated with that of miR-370-3p (r=-0.394, P＜0.05). Circ_BACH2 and miR-370-3p has a binding site at the 3' UTR of GIT1. After knocking down circ_BACH2, the proportion of G0/G1 cells in papillary thyroid cancer cells TPC-1 and SW579 was increased, the proportion of S-phase cells was decreased and the proportion of G2/M-phase cells did not change significantly. The cell absorbance value was lower than that in si-NC group. The number of cell clone formation was decreased (43±5 vs 100±6, 54±8 vs 100±9); the cell apoptosis rate was increased [(19.60±2.40)% vs (4.30±0.20)%, (18.10±2.10)% vs (5.10±0.23)%]; cell migration number was decreased (61±7 vs 134±15, 58±6 vs 112±11), the invasion number was also decreased (45±6 vs 113±11, 47±4 vs 92±9); the expressions of Snail and Twist1 were decreased, and the expression of E-cadherin was increased (P＜0.000). Inhibition of miR-370-3p expression reversed the effect of circ_BACH2 knockdown on proliferation, migration, invasion and apoptosis of thyroid papillary cancer cells. Overexpression of GIT1 reversed the effects of overexpression of miR-370-3p on proliferation, migration, invasion and apoptosis of thyroid papillary cancer cells. Mice injected with TPC-1 cells stably transfected with sh-circ_BACH2 showed a reduction in tumor volume [(535±91) mm3 vs (857±114) mm3] after 35 days of culture; tumor weight was decreased [(0.62±0.13) mg vs (1.06±0.15) mg, P＜0.05]; the expressions of circ_BACH2 and GIT1 were decreased, and the expression of miR-370-3p was increased in nude mouse tumor tissue. Conclusion: Silencing circ_BACH2 may inhibit the proliferation, migration and invasion of papillary thyroid cancer cells in vitro, promote cell apoptosis, and inhibit tumor growth in vivo through targeted regulation of miR-370-3p/GIT1.

Abstract Objective: Previous epidemiological observational researches have suggested a potential connection between autoimmune thyroid disease (AITD) and osteoarthritis (OA); however, the results are inconclusive. It remains unclear whether the association between AITD and OA is causal. This Mendelian randomization (MR) study was conducted to specifically explore whether there is a genetic causal link between OA and AITD disease. Methods: Derived from a comprehensive genome-wide association study involving individuals of European descent, our study carefully chose specific single nucleotide polymorphisms (SNPs) as instrumental variables for two distinct forms of KOA and HOA. We evaluated two types of AITD: autoimmune hypothyroidism and autoimmune hyperthyroidism. MR Egger, Weighted median, Simple mode, Weighted mode and Inverse Variance Weighting (IVW) were used in our study to estimate whether there was a genetic level of causality between AITD and OA, and the IVW method prevailed in the assessment. Additionally, we conducted tests for heterogeneity and sensitivity to ensure the robustness of our findings. Results: IVW analysis revealed a significant impact of autoimmune hyperthyroidism on the incidence of KOA. (OR: 1.0512; 95% CI: 1.0197–1.0836, P = 0.001285396). Other results had a P-value > 0.05, showing all negative. Conclusions Our findings indicated a genetic causal association between autoimmune hyperthyroidism and the risk of KOA, despite observational studies reporting an association between autoimmune hypothyroidism and OA and provided new insight into the treatment strategies for OA and AITD.