Malnutrition and sarcopenia may occur concurrently (Malnutrition-sarcopenia syndrome, MSS) in gastric cancer patients, affecting the prognosis and clinical outcomes. This study aimed to evaluate MSS prevalence and oral nutritional supplements (ONS) efficacy. This study included a retrospective analysis of 761 gastric cancer patients post-resection to assess MSS prevalence/prognosis, and a prospective non-randomized trial enrolled 81 MSS patients comparing ONS (500 kcal/day ×4 wk) versus standard care. In the retrospective cohort, MSS prevalence was 20.2%, and MSS independently predicted higher postoperative complication (OR: 2.330, 95% CI: 1.256-4.321, p = 0.007), recurrence/metastasis (OR: 4.162, 95% CI: 1.965-8.815, p < 0.001) and worse overall survival (HR: 1.649, 95% CI: 1.007-2.700, p = 0.047). In the prospective trial, ONS significantly improved weight maintenance compared to standard care (p = 0.032). Non-significant trends were observed in ONS group for shorter postoperative length of stay (PLOS) (6.8 vs 8.0 days), fewer complications (5.0% vs 22.0%) and improved handgrip strength (HGS) recovery (0.1 kg vs -0.9 kg). MSS is prevalent in gastric cancer and associated with adverse outcomes. ONS effectively preserves weight and shows recovery benefits, supporting its integration into MSS management.

BackgroundModifiable risk factors are major drivers of cardiovascular disease (CVD). We aimed to determine the epidemiological trend and age-period-cohort effects on CVD burden attributable to dietary risks and high body mass index (BMI) across China and Pakistan from 1990 to 2019.MethodsData on the all-ages and age-specific CVD burden, age-standardized CVD mortality and disability-adjusted life years (DALYs) rates were obtained from the Global Burden of Disease Study 2019. Joinpoint regression analysis was conducted to find temporal trends and age-period-cohort (APC) modeling was used to estimate age, period, and cohort effects on CVD burden.ResultsBetween 1990 and 2019, the all-ages CVD burden attributable to dietary risks and high BMI increased by ~2-3-fold in China and by 3-5-fold in Pakistan. The diet-related CVD age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life years (DALYs) rate significantly decreased in China but increased in Pakistan. Both countries showed a marked increasing trend of CVD ASMR and the age-standardized DALYs rate attributable to high BMI. Taiwan in China showed a remarkable reduction in CVD burden. However, in Pakistan, all regions observed a significantly increasing trend of CVD burden attributable to modifiable risk factors. A higher risk ratio of premature CVD mortality (<70 years) was observed among Chinese attributable to high BMI and among Pakistani attributable to dietary risks. In China, early birth cohorts showed a higher risk ratio and recent birth cohorts experienced a lower risk ratio of CVD burden compared with Pakistan.ConclusionIn conclusion, dietary risks and high BMI caused a huge CVD burden across China and Pakistan.

Chronic obstructive pulmonary disease (COPD) is a common, chronic heterogeneous airway disease. Although recent years have witnessed growing advances in both COPD research and management, there are still many difficulties need to be solved urgently. In view of this, the Lancet published Towards the Elimination of Chronic Obstructive Pulmonary Disease in September 2022, a document in which new ideas on the recognition, diagnosis, assessment and individualized treatment of COPD and relevant clinical guidance were proposed. This article focuses on the introduction and interpretation of the classification, diagnostic criteria and diagnostic recommendations of COPD in this document, the acute exacerbation of COPD and the move towards elimination of COPD, hoping to provide insights into COPD research and management conducted by Chinese clinical workers.

目的:构建术后稳定期造口旁疝的临床预测模型,并进行内部验证和外部验证.方法:选取2013年10月——2019年12月上海市某三级甲等综合性医院739例肠造口病人作为建模集.采用问卷调查、查阅数据库和电话、网络随访等方式获取病人资料,基于竞争风险模型构建造口旁疝临床预测模型.使用Bootstrap重复抽样法对该模型进行内部验证.选取2020年1月—2020年12月120例肠造口病人作为验证集,对模型进行外部验证.采用C-统计量和ROC曲线下面积评价模型的区分度.结果:年龄、术后体质指数(BMI)、前列腺肥大、咳嗽、提举重物、造口腹带的使用、造口旁疝相关指导、腹肌锻炼以及体重变化是造口旁疝的独立影响因素,而糖尿病、造口性质、体力劳动、排泄情况接近临界值.术后稳定期预测列线图的C-指数为0.921,无论是内部抑或外部验证区分度均较为理想.结论:术后稳定期的造口旁疝临床预测模型能很好地预测造口旁疝的发生风险,能指导病人对自身情况实时评估,以便及时预防.

Abstract Background The research explored the relationship between perceived social support, illness perception, symptom burden, and self-management ability of postoperative elderly patients with lung cancer. Methods A cross-sectional survey was administered to 489 eligible participants using Chinese version of the Perceived Social Support Scale, Chinese version of the M.D. Anderson Symptom Inventory-Lung Cancer module, Chinese version of the brief illness perception questionnaire, and Cancer Patient Self-management Assessment Scale. Results A significantly positive association was found between perceived social support and self-management ability of postoperative elderly patients with lung cancer,( r = 0.565, and P༜0.001) and a negative relationship between symptom burden, illness perception, and their self-management ability. (r = -0.442, − 0.203, and P༜0.001). Conclusion This research emphasizes the importance of perceived social support, illness perception, and symptom burden in exploring self-management ability so that healthcare providers can develop more effective strategies to increase self-management ability.

ObjectiveTo analyze status quo and hotspots of parastomal hernia by bibliometric methods.MethodsLiterature related to parastomal hernia was retrieved from Web of Science and CNKI.The retrieval period was from the establishment of databases to 31 December，2020.VOSviewer，CiteSpace and Graphpad 8 were mainly used to analyze search results.ResultsA total of 2 255 literature related to parastomal hernia were included，including 262 Chinese literature and 1 993 English literature.The increased rate of English literature related to parastomal hernia was faster from 2001 to 2017，and the increased rate of Chinese literature was slower.Among English literature，The United States had published the most literature（404 literature），and the University of California had the most active research.China had published with the second largest number of literature（146 literature）.Among Chinese literature，Huashan Hospital affiliated to Fudan University had the most active research.The degree of collaboration among authors of Chinese literature was 2.56，and author's co⁃authoring rate was 81.30%.The degree of collaboration among authors of English literature was 2.93，and author's co⁃authoring rate was 97.27%.The core author group in the field of parastomy hernia research had not yet formed.The research hotspots in China and abroad was basically the same，and prevention and treatment were research hotspots.ConclusionsThe research on parastomal hernia has certain development prospects.Chinese researchers should learn from foreign research experience to further improve quality of parastomal hernia research in China.

目的 探讨肺癌化疗患者癌因性疲乏变化轨迹及其影响因素.方法 采用前瞻性研究方法,选择2020年12月至2021年12月在复旦大学附属中山医院首次接受化疗的肺癌患者250例,收集患者前6次化疗的化疗前、化疗结束时、化疗结束后1周的癌因性疲乏情况.采用混合增长模型识别患者疲乏轨迹类型,采用logistic回归分析癌因性疲乏的影响因素.结果 共识别出6种肺癌患者癌因性疲乏变化轨迹,分别为轻度疲乏稳定型(114例,45.78％)、轻度疲乏缓慢增长型(32例,12.85％)、轻度疲乏高增长型(13例,5.22％)、中度疲乏缓慢增长型(49例,19.68％)、中度疲乏缓解型(17例,6.83％)及高度疲乏缓解型(24例,9.64％).Logistic回归分析显示,职业、居住方式、家庭人均月收入、医疗负担、咳嗽、吸烟状况、体质指数、呕吐、是否患有合并症、红细胞计数为癌因性疲乏的影响因素(P<0.05).结论 肺癌化疗患者从首次化疗至6次化疗结束,癌因性疲乏呈现6种发展轨迹,存在个体差异,不同阶段影响因素不同,建议医护人员根据患者不同发展特点及影响因素提供个性化干预措施.

目的 应用竞争风险模型评估肠造口旁疝(parastomal hernia,PSH)的发病风险及影响因素.方法 回顾性分析2015年至2019年735例行肠造口术患者的临床资料.通过Cox模型评估PSH的累计发生率.当死亡和回纳作为竞争事件出现时,采用Fine-Gray模型进行分析.结果 中位随访17.1个月,其间,136例(18.5％)发生PSH,PSH出现的中位时间为10个月.单因素Cox回归分析和单因素Gray检验显示,年龄、术前体质指数(BMI)、高血压、前列腺肥大、造口途径与PSH的发生相关.多因素Cox回归分析和多因素Fine-Gray模型均显示,年龄≥60岁、术前BMI≥25 kg/m2和经腹膜外造口术是PSH发生的独立影响因素.此外,多因素Fine-Gray模型显示,乙状结肠造口也是PSH的独立影响因素.使用Kaplan-Meier法分析发现,肠造口患者随访1年、2年和5年的PSH累计发生率分别为20.5％、29.8％和37.6％;使用Fine-Gray模型分析发现,肠造口患者随访1年、2年和5年的PSH累计发生率分别为13.69％、20.07％和25.31％.与Kaplan-Meier或Cox法相比,Fine-Gray模型对PSH累计发生率的估计始终较低.结论 在存在竞争风险的情况下,相比于Kaplan-Meier和Cox模型,Fine-Gray模型能更准确地评估与PSH发生相关的高危因素以及PSH的累计发生率.

目的:采用网状Meta分析的方法评价不同电动牙刷组合方法在重症加强护理病房(ICU)气管插管病人口腔卫生方面的效果.方法:计算机检索the Cochrane Library、PubMed、Web of Science、CINAHL、EMbase、中国生物医学文献数据库(CBM)、中国知网(CNKI)、万方数据库和维普数据库,检索时间限定为从建库至2020年12月13日,筛选出ICU气管插管病人使用电动牙刷相关的研究,并进行文献质量评价,使用Stata 15.1软件对数据进行网状Meta分析.结果:共纳入20篇相关文献,涉及12种口腔护理方式.网状Meta分析结果显示电动牙刷较常规护理在提高ICU气管插管病人口腔卫生方面具有显著效果.排序概率图显示电动牙刷蘸取牙膏结合生理盐水冲洗、负压吸引效果最好,常规护理和纯净水冲洗的效果最不理想,其余电动牙刷组合方式的效果居中.结论:现有证据表明,12种口腔护理方式中,电动牙刷蘸取牙膏结合生理盐水冲洗、同步负压吸引的效果最好,可达到提高ICU气管插管病人口腔卫生的效果.

目的 构建住院期间和出院后肠造口患者发生造口旁疝的临床预测模型并验证.方法 选取某三级甲等综合性医院2015年1月1日-2019年12月31日的735例肠造口患者,通过LASSO筛选预测变量,基于Cox比例风险回归模型构建预测模型,采用ROC曲线、校准曲线以及决策曲线分析(DCA)评价预测模型的预测效能.结果 (1)住院期间预测模型为h(x)=0.373 1×性别+0.794 6×年龄-0.311 0×支付方式-0.401 7×宗教信仰+0.048 0×教育程度+0.655 9×饮酒史+0.572 4×身高+0.681 4×术前 BMI+0.109 6×高血压+0.142 6×糖尿病+0.454 9×腹部手术-0.599 6×术前放疗+0.952 8×术前化疗+0.168 6×术前定位-0.523 6×手术时机-0.276 9×手术方式-0.045 7×造口部位+0.053 4×造口方式-1.019 1×造口性质+0.740 4×腹直肌.(2)出院后预测模型为h(x)=0.759 1×体力劳动+0.825 5×剧烈咳嗽-0.701 4×造口腹带-0.608 1×术后指导+0.587 4×术后化疗-0.036 6×术后放疗-1.871 4×排泄通畅-0.605 7×腹肌锻炼+0.585 7×术后体质量变化.住院期间灵敏度为0.639 5,特异度为0.734 6,约登指数为0.374 1;出院后灵敏度为0.854 5,特异度为0.801 5,约登指数为0.656 0.住院期间模型ROC曲线下面积为0.752 0;出院后模型为0.914 0.模型的验证结果显示:住院期间ROC曲线下面积为0.622 0,出院后为0.770 0,提示其预测效果较好.结论 肠造口患者造口旁疝临床预测模型能较好地预测造口旁疝的发生风险,能帮助临床医护人员及时筛选出高危人群,给予重点关注,并指导其重点预防.

Objective: We aimed to investigate the effects of exercise, monitored and managed using smart bracelets, on body composition, and quality of life in breast cancer survivors. Methods: A before-and-after study was conducted in 109 patients who were in the recovery phase of breast cancer and attended the Breast Surgery Department of the Cancer Hospital of Fudan University up to December 2017. Patients were advised to adhere to at least 150 minutes of moderate-intensity exercise per week, and a smart bracelet was issued to each participant to record their daily exercise data for 3 months. Bioelectrical impedance analysis was used to observe the effects of short-term unsupervised exercise intervention on body composition in patients recovering from breast cancer. Patients completed the Functional Assessment of Cancer Therapy-Breast to assess health-related quality of life. Results: Weight, body mass index (BMI), body fat mass (BFM), fat mass index (FMI), percent body fat (PBF), arm circumference (AC), arm muscle circumference (AMC), and visceral fat area (VFA) were lower than baseline after exercising for 3 months based on data from the wearable devices ( P < .05). The only significant improvement was found in the “additional concerns about breast cancer” category among the quality-of-life assessments ( P < .05). The average walking time was negatively associated with BFM, PBF, and FMI, while the average calorie consumption due to running was positively associated with fat free mass (FFM). Conclusion: In this study, we demonstrated that short-term exercise may be beneficial for postoperative breast cancer survivors. A wearable device could help patients track physical data easily and promote a healthier and more positive life.

目的:探讨饮食类型对造口周围潮湿相关性皮肤损伤(peristomal moisture-associated skin damage,PMASD)的影响.方法:采用方便抽样法选取2019年11月至2020年9月复旦大学附属中山医院、复旦大学附属肿瘤医院、海军军医大学第一附属医院和上海交通大学医学院附属新华医院收治的行肠造口术患者362例.根据患者饮食类型分为普食、软食、半流质、流质4组,定期随访所有患者至术后3个月.采用统一的PMASD评定表和肠造口患者调查表收集结局变量和其他预测变量资料,采用R软件的logistic逐步回归法分析饮食类型对PMASD的预测效能并纳入其他预测变量进行校正.结果:共329例患者完成随访,发生PMASD 141例(42.8％),其中普食组37例(26.2％)、软食组48例(34.1％)、半流质组56例(39.7％).软食及半流质在校正前后均为独立预测因子,校正后OR值分别为6.30(95％CI 3.31～12.32,P＜0.001)和8.99(95％CI 4.47～18.81,P＜0.001),模型校正前后的拟合效果均良好,AUC分别为0.767(95％CI 0.718～0.815)和0.845(95％CI 0.804～0.886).结论:饮食类型是造口周围潮湿相关性皮肤损伤的重要影响因素;与普食相比,软食和半流质会增加PMASD风险且半流质风险高于软食.

目的:初步构建脊髓损伤简要版《国际功能、残疾和健康分类（ICF）》核心组合"活动与参与"各类目限定值评定细则,筛选类目限定值的评定方法,提高其临床应用的可操作性。方法:在文献回顾和书籍查阅基础上形成初版评定细则,通过德尔菲法进行增删或修改,最后在15例脊髓损伤病人中运用,根据实践中出现的问题对评定细则做进一步调整。结果:初步构建出包含12个类目、61项评定指标、3种评定方法、12套评分标准的脊髓损伤简要版ICF核心组合"活动与参与"成分各类目限定值评定细则。结论:构建的简要版脊髓损伤ICF核心组合"活动与参与"评定细则具有一定的科学性和实用性,下一步可结合病人的个体特点在更大样本量的脊髓损伤病人中应用以验证其有效性。

目的:总结、评价结直肠术后病人加速康复外科出院标准的最佳证据,为临床实践提供参考.方法:计算机检索BMJ Best Practice、Up To Date、Canadian Anesthesiologists′Society官网、American Society of Anesthesiologists Committee官网、European Society of Anesthesiology官网、Joanna Briggs Institute Library、Cochrane Library、PubMed、EMbase、中国生物医学文献服务系统(CBM)、中国期刊全文数据库(CNKI)、万方数据库资源系统中的临床决策、指南、证据总结、最佳实践信息册、系统评价、系统综述、专家共识,对文献质量进行评价和资料提取,对符合质量标准的文献进行证据提取.结果:形成了包括出院时间、口服耐受性、肠道功能恢复、疼痛控制、活动与自理能力、临床检查、实验室检查、病人意愿、并发症风险和出院评估工具10个主题、16条最佳证据.结论:建议将口服耐受性、疼痛控制和充分活动、下消化道功能恢复、活动和自理能力、临床检查正常及相关实验室检查合格作为结直肠术后病人加速康复外科的出院标准.

目的 探索肠造口患者术后3个月内造口周围潮湿相关性皮肤损伤(peristomal moisture-associated skin damage,PMASD)影响因素.方法 采取前瞻性队列设计,便利选取2019年11月-2020年9月在上海4所三级甲等医院接受肠造口术的329例患者为研究对象,采用自制的肠造口患者调查表对其进行调查.结果 肠造口患者PMASD发生率为42.8％(141/329).Logistic回归分析显示:性别(OR=0.527,P=0.029)、造口开口高度值(OR=0.323,P＜0.001)、底盘区域手术伤口(OR=3.143,P=0.004)、造口部位(OR =4.109,P＜0.001)、底盘渗漏次数＞(3次)(OR=2.679,P=0.009)、软食(OR=2.854,P=0.003)、半流质饮食(OR=2.977,P＜0.001)为PMASD的影响因素.结论 PMASD为肠造口术后3个月内常见并发症,可为患者提供造口开口高度观察、造口产品选择、特殊敷料使用、饮食过渡时机及方法等方面的指导,以降低并发症发生风险.

目的:总结肠造口病人自我管理的评估工具,为临床医护人员认识和选择合适的评估工具提供参考.方法:系统检索、提取和总结CINAHL、PubMed、SinoMed和万方数据库建库至2020年6月30日有关肠造口病人自我管理评估工具的文献.结果:纳入9篇文献,总结出8种评估工具,分别是自我管理能力量表(Self Management Ability Scale,SMAS)、视觉模拟评分法(Visual Analogue Scale,VAS)、肠造口病人自我管理能力评估表(Development of Self-Care Competence of the Person with an Intestinal Stoma,CAO-EI:ESEP)、肠造口病人自我管理问卷、肠造口病人自我管理行为问卷、造口病人专门自我护理问卷(Specific Self-Care for Ostomized Patients Questionaire,CAESPO)、造口自理指数(Ostomy Self-Care Index,OSCI)和造口病人自我管理量表.结论:综合评估各工具的科学性、实用性和适用性,在我国可优先选择肠造口病人自我管理行为问卷对肠造口病人自我管理行为进行评估.

目的 构建肠造口周围潮湿相关性皮肤损伤(peristomal moisture-associated skin damage,PMASD)风险预测模型并应用于临床,验证该模型的预测效果.方法 采用前瞻性研究设计,便利选取2019年11月—2020年9月在上海市4所三级甲等医院接受肠造口术的329例患者作为建模组,根据患者术后3个月内是否发生PMASD分为并发症组(141例)和非并发症组(188例),基于单因素分析、Lasso变量筛选结果构建Logistic回归预测模型.采用Hosmer-Lemeshow检验判断模型的拟合度,受试者操作特征曲线下面积检验模型的区分度,Bootstrap重抽样法进行内部验证.于2020年10月—11月选取109例患者作为验证组对模型进行外部验证.结果 建模组术后3个月内PMASD发生率为42.9％(141/329),验证组为37.6％(41/109).最终纳入模型的预测变量为性别(OR=0.497)、造口部位(OR=4.338)、造口开口高度(OR=0.304)、底盘区域手术切口(OR=3.479)、底盘贴合情况(OR=2.399)、软食(OR=3.155)、半流质饮食(OR=3.325).Hosmer-Lemeshow检验P=0.274,受试者操作特征曲线下面积为0.812,约登指数为0.500,灵敏度为0.688,特异度为0.798.外部验证Hosmer-Lemeshow检验P=0.515,受试者操作特征曲线下面积为0.860,灵敏度为0.610,特异度为0.882.结论 该研究构建的预测模型预测效能良好,可为临床护理人员筛选PMASD高风险患者提供参考.

Background: Tai Chi is a systematic whole body movement developed in ancient China. It plays an increasingly important role in the field of pulmonary rehabilitation for patients with chronic obstructive pulmonary disease (COPD). Our review aimed to explore the impact of Tai Chi on the physical and mental health of patients with COPD. Methods: We searched several English and Chinese databases and used the combination of subject words and free words to search for available literature from the establishment of the library until August 28, 2018. Two researchers screened studies and collected the data independently. The study inclusion criteria included: (I) patients diagnosed with COPD; (II) Tai Chi or Tai Chi Qigong as an intervention in addition to routine treatment; (III) routine treatment with or without exercises as control group. The primary outcomes were lung function, exercise capacity and health status; (IV) randomized controlled trials. Results: Sixteen articles were included from 2009 to 2018 (n=1,096). The average time duration of Tai Chi program was 53.4 minutes each session, 4.13 sessions a week for a total of 4.13 months. Comparing with control group, Chi group improved some lung function (forced volume capacity: mean difference =0.12, 95% CI: 0.03-0.21), (forced expiratory volume in Is: mean difference =0.15, 95% CI: 0.08-0.21), enhanced 6-minute walking distance score (mean difference =30.78, 95% CI: 15.15-46.42), decreased COPD Assessment Test score (mean difference =-5.00, 95% CI: -7.51 to -2.50), decreased St. George's Respiratory Questionnaire score (mean difference =-8.66, 95% CI: -14.60 to -2.72), enhanced Chronic Respiratory Disease Questionnaire score (mean difference =2.16, 95% CI: 1.49-2.83), decreased Hospital Anxiety and Depression Scale score(anxiety: mean difference =-1.04, 95% CI: -1.58 to -0.51; depression: mean difference =-1.25, 95% CI: -1.77 to -0.73). Comparing with exercise group, Tai Chi group statistically enhanced 6-minute walking distance score (mean difference =7.77, 95% CI: 2.63-12.91). Conclusions: Tai Chi may represent an appropriate alternative or complement to standard rehabilitation programs. However, whether Tai Chi is better than pulmonary rehabilitation exercise has not been determined.

目的:构建简要版慢性阻塞性肺疾病(COPD)国际功能、残疾和健康分类(International Classification of Functioning,Disability and Health,ICF)核心组合"活动与参与"类目评测模型.方法:运用文献回顾法构建初版COPD-ICF核心组合"活动与参与"类目评测模型;采用德尔菲专家函询法对16名专家进行2轮问卷调查,根据问卷调查结果,对模型中的评定指标及评定方法进行修改及完善.结果:2轮函询问卷的有效回收率分别为100％ 和87.5％;专家权威系数分别为0.816和0.828.函询过程中,专家具有较高的积极度及协调性.构建出COPD-ICF核心组合"活动与参与"类目评测模型.结论:COPD-ICF核心组合"活动与参与"类目评测模型的建立是制定评定细则的重要一步,可为后期收集大样本数据进行量化分级以及实测提供基础,以便于制定完整的评定细则.

[目的]系统评价影响肠造口周围皮肤并发症发生的因素.[方法]计算机检索the Cochrane Library、JBI、中国生物医学文献数据库(CBM)、知网、万方、Web of Science、PubMed、CINAHL等中英文数据库,检索时限均为从建库至2019年8月31日,由2名研究者分别独立进行文献的筛选和信息提取、利用澳大利亚JBI卫生保健中心质量评价工具(2016版)对文献质量进行评价,对研究结果进行描述性分析.[结果]按照纳入和排除标准最终纳入24篇文献.定性分析结果显示:依据不同影响因素进行分类归纳,将影响肠造口周围皮肤并发症的因素分为一般资料相关因素、手术相关因素、造口本身因素、排泄相关因素、造口护理、教育和指导相关因素、原发疾病、并存疾病、辅助治疗相关因素、造口用品和经济相关因素7个方面33个因素.[结论]当前证据显示,影响肠造口周围皮肤并发症发生因素较多,但由于纳入文献总体质量不高,同时,研究间在研究设计、结局指标选择方面存在较大异质性,因此期待更多高质量研究进一步验证.