Effects of pooling,specialization,and discretionary task completion on queueing performance

Pooling,unpooling/specialization,and discretionary task completion are typical operational strategies in queueing systems that arise in healthcare,call centers,and online sales.These strategies may have advantages and disadvantages in different operational environments.This paper uses the M/M/1 and M/M/2 queues to study the impact of pooling,specialization,and discretionary task completion on the average queue length.Closed-form solutions for the average M/M/2 queue length are derived.Computational examples illustrate how the average queue length changes with the strength of pooling,specialization,and discretionary task completion.Finally,several conjectures are made in the paper.

Specialization or Diversification:Which is More Conducive to Foreign Trade Resilience?Evidence from China-Russia Border Regions in Northeast China

Under the background of complex international situation,how to build the special geo-economic space of China-Russia bor-der lies in strengthening their foreign trade resilience against external shocks.Based on empirical evidence from ten prefecture-level China-Russia border regions in Northeast China,this paper analyzed the spatiotemporal evolution of foreign trade resilience under dif-ferent shocks.Furthermore,through the Panel Regression model,the mechanism of the industrial structure on the foreign trade resili-ence in contraction period and expansion period was discussed.The results showed that:1)from 2004 to 2021,foreign trade in China-Russia border regions experienced five phases.The overall foreign trade resilience was higher than expected,showing a rising volatility trend,but there was significant spatial heterogeneity in the ability of cities to cope with shocks.2)Highly specialized clusters were mainly concentrated in Yichun,Heihe and Da Hinggan Ling Prefecture,while Mudanjiang and Yanbian performed better in related and unrelated diversification.3)In different stages of economic system evolution,the response mode,degree and result of border foreign trade resilience to regional industrial structure showed obvious stage characteristics.During the contraction period,related diversifica-tion was more conducive to improving the resistance through risk spillovers.During the expansion period,specialization played a more significant role in improving regional resilience through self-reinforcing effect.These results are beneficial for expanding the resilience theory,ensuring border economic security and optimizing border industrial investment layout.

Rural Development Transformation and Social Governance from the Perspective of Specialization:A Case Study of Ruiling Village in Guangzhou City,China

The reorganization of the global production network and the increased mobility of urban-rural elements have accelerated the differentiation of rural spaces,resulting in a trend towards specialization in rural areas.This paper focuses on the concept of specialization,and takes a renowned bonsai specialized village in Guangzhou City,China as a typical case to explore its transformation and development process,action logic and coupling mechanism with the social governance.The results show that:1)the development of rural specialization in Ruiling Village is shaped by several key actors,such as local governments,grassroots organizations,villagers,social organizations,policies,markets and infrastructure.The transfer of these key actors and the reconstruction of actor-networks in different stages have an important influence on the transformation and realization of rural development goals.2)Through subjects-driven,organization management and resource connection,social governance supports the specialization of rural industrial organization,operation,technology and mode.The governance structure shifts from decentralization to networking,refinement and integration.A coupling community of social governance and specialization is created by the social governance system of‘local government-grassroots organizationseconomic cooperatives-villagers’,which links industries,industrial chains and cooperatives.3)Social governance integrates into the value chain extension process of rural specialized development with a central,multi-level organizational structure.It promotes the construction of the whole value chain through organizational planning,resource integration and image shaping,thus realizing the value,branding and organization of the industry,as well as the integration of rural sustainable development and governance mechanism.Social governance has a profound impact on the development of rural specialization in terms of subject,structure and mode,and participates in the construction of the whole value chain of rural areas.This paper provides a new perspective for understanding the coupling effect of social governance in the rural development transformation,and promotes the rural sustainable development and governance.

Spectral purification improves monitoring accuracy of the comprehensive growth evaluation index for film-mulched winter wheat

In order to further improve the utility of unmanned aerial vehicle(UAV)remote-sensing for quickly and accurately monitoring the growth of winter wheat under film mulching, this study examined the treatments of ridge mulching,ridge–furrow full mulching, and flat cropping full mulching in winter wheat.Based on the fuzzy comprehensive evaluation (FCE) method, four agronomic parameters (leaf area index, above-ground biomass, plant height, and leaf chlorophyll content) were used to calculate the comprehensive growth evaluation index (CGEI) of the winter wheat, and 14 visible and near-infrared spectral indices were calculated using spectral purification technology to process the remote-sensing image data of winter wheat obtained by multispectral UAV.Four machine learning algorithms, partial least squares, support vector machines, random forests, and artificial neural network networks(ANN), were used to build the winter wheat growth monitoring model under film mulching, and accuracy evaluation and mapping of the spatial and temporal distribution of winter wheat growth status were carried out.The results showed that the CGEI of winter wheat under film mulching constructed using the FCE method could objectively and comprehensively evaluate the crop growth status.The accuracy of remote-sensing inversion of the CGEI based on the ANN model was higher than for the individual agronomic parameters, with a coefficient of determination of 0.75,a root mean square error of 8.40, and a mean absolute value error of 6.53.Spectral purification could eliminate the interference of background effects caused by mulching and soil, effectively improving the accuracy of the remotesensing inversion of winter wheat under film mulching, with the best inversion effect achieved on the ridge–furrow full mulching area after spectral purification.The results of this study provide a theoretical reference for the use of UAV remote-sensing to monitor the growth status of winter wheat with film mulching.

Effect of a comprehensive geriatric assessment nursing intervention model on older patients with diabetes and hypertension

BACKGROUND The Comprehensive Geriatric Assessment(CGA)was introduced late in China and is primarily used for investigating and evaluating health problems in older adults in outpatient and community settings.However,there are few reports on its application in hospitalized patients,especially older patients with diabetes and hypertension.AIM To explore the nursing effect of CGA in hospitalized older patients with diabetes and hypertension.METHODS We performed a retrospective single-center analysis of patients with comorbid diabetes mellitus and hypertension who were hospitalized and treated in the Jiangyin Hospital of Traditional Chinese Medicine between September 2020 and June 2022.Among the 80 patients included,40 received CGA nursing interventions(study group),while the remaining 40 received routine nursing care(control group).The study group's comprehensive approach included creating personalized CGA profiles,multidisciplinary assessments,and targeted inter-ventions in areas,such as nutrition,medication adherence,exercise,and mental health.However,the control group received standard nursing care,including general and medical history collection,fall prevention measures,and regular patient monitoring.After 6 months of nursing care implementation,we evaluated the effectiveness of the interventions,including assessments of blood glucose levels fasting blood glucose,2-h postprandial blood glucose,and glycated hemoglobin,type A1c(HbA1c);blood pressure indicators such as diastolic blood pressure(DBP)and systolic blood pressure(SBP);quality of life as measured by the 36-item Short Form Survey(SF-36)questionnaire;and treatment adherence.RESULTS After 6 months,the nursing outcomes indicated that patients who underwent CGA nursing interventions experienced a significant decrease in blood glucose indicators,such as fasting blood glucose,2-h postprandial blood glucose,and HbA1c,as well as blood pressure indicators,including DBP and SBP,compared with the control group(P<0.05).Quality of life assessments,including physical health,emotion,physical function,overall health,and mental health,showed marked improvements compared to the control group(P<0.05).In the study group,38 patients adhered to the clinical treatment requirements,whereas only 32 in the control group adhered to the clinical treatment requirements.The probability of treatment adherence among patients receiving CGA nursing interventions was higher than that among patients receiving standard care(95%vs 80%,P<0.05).CONCLUSION The CGA nursing intervention significantly improved glycemic control,blood pressure management,and quality of life in hospitalized older patients with diabetes and hypertension,compared to routine care.

The Hesitance of Nurses to Apply for Midwifery Specialization: Explorative Qualitative Study

Background: Many countries across the world are facing an ongoing shortage of midwife practitioners due to several reasons such as increased workload, working overtime, poor-quality midwifery care, low staff morale, stress and burnout, lack of opportunity for training, lack of management support, financial issues and lack of recognition and compromised autonomy. Purpose: To explore the reasons behind nurses’ hesitance to apply for midwifery specialization. The objectives of this study were to understand the challenges that lie in front of Omani nurses and the motivational factors to apply for a midwifery programme. Method: Exploratory qualitative study was conducted at the largest tertiary hospital in Oman. Purposive sampling was applied for participant recruitment. Face-to-face interviews and focus group discussions were used as data collection methods. The study included general nurses, nurses in charge working in the maternity unit as well as nurses whose applications were accepted for midwifery education. Qualified midwives were excluded. The data collection process yielded twenty-five nurses. The interview protocol highlighted the impact and perception of the midwifery specialization on nurses’ careers. Thematic analysis was employed for data analysis. Results: Three over-arching major themes were identified. These are 1) nurses’ perceptions about the nature of work in maternity wards, the nurses have positive perception toward working in maternity wards and labor room because of working exclusively with female patients and their babies 2) factors influencing the decision to study midwifery specialization, work overload, stress, lack of support from administration were the most common reason behind the nurses not to apply for midwifery specialization and 3) support and recommendations required for midwives, the nurses mentioned that their identity, promotions and support from the administration will encourage them to apply for midwifery specialization. Conclusion: One of the main reasons that hindered nurses from applying to midwifery specialization is the false belief that midwives cannot work outside the delivery suite (DS). The second reason was the stress that midwives encounter at DS, and this was perceived by general nurses who did not work at DS. These challenges could be mitigated by leadership support, midwifery profession identity, as well as financial recognition for the midwives.

Effect of comprehensive nursing on the quality of life and swallowing function in individuals diagnosed with ischemic stroke

BACKGROUND Ischemic stroke(IS)is a widely recognized disease characterized by high preva-lence,mortality,morbidity,disability,and recurrence rates.It ranks prominently in terms of mortality,constituting 60%-80%of stroke cases.AIM To explore the impact of comprehensive nursing care on the quality of life and swallowing function in individuals diagnosed with IS.METHODS This study comprised 172 patients with IS admitted to our hospital between February 2018 to March 2021.The participants were divided into two groups,namely the control group(n=80)receiving routine care and the research group(n=92)receiving comprehensive care.Various assessment scales,including the standard swallowing function assessment scale(SSA),National Institutes of Health Stroke scale(NIHSS),European stroke scale(ESS),self-rating anxiety scale(SAS),self-rating depression scale(SDS),Barthel index(BI),and the motor func-tion assessment scale(MAS),were employed to evaluate the improvement in swallowing function,neurological deficits,clinical outcomes,anxiety,depression,daily living activities,and motor function before and after care.Furthermore,the study compared the occurrence of adverse reactions during the nursing period,life quality before and after the intervention,rehabilitation compliance,and nursing satisfaction between the two groups.RESULTS After the nursing intervention,the research group exhibited significantly improved SSA and NIHSS scores compared to the control group(P<0.05).Moreover,both groups demonstrated significant reductions in SAS and SDS scores(P<0.05),with the research group showing more obvious advantages(P<0.05).Compared to the control group,the research group displayed significantly better ESS,BI,and MAS scores(P<0.05),coupled with a lower incidence of adverse reactions(P<0.05).Additionally,the research group demonstrated markedly higher levels of life quality,rehabilitation compliance,and nursing satisfaction compared to the control group(P<0.05).CONCLUSION Comprehensive nursing effectively improved swallowing function,quality of life,and patient satisfaction,high-lighting its clinical significance.

Comprehensive Evaluation of Flower Border Application Value of New and Superior Plants in Hefei Area

An analytic hierarchy process(AHP)was employed to assess the applicability of 18 new and superior varieties of flowers in Hefei City flower border applications.A total of 12 indicators were selected from three distinct aspects of adaptability,ornamental characteristics and use traits,in order to establish a comprehensive evaluation model.The results demonstrate that grade I(J≥2.685)exhibits excellent application value,encompassing six species of plants,such asHydrangeamacrophylla‘Endless Summer’;grade II(2.684≤J≤2.420)is also of notable application value,encompassing five species of plants,such asCallistemonrigidus;grade III(2.419≤J≤2.615)is of average application value,including five species of plants,such asCrocosmiacrocosmiflora;grade IV(J≤2.16)is of relatively poor application value.The evaluation results may be utilized as a theoretical reference for the promotion of new and superior varieties in the flower border of Hefei.

Application of Specialized Group Management in the Quality Control of Perioperative Nursing

Objective:To explore the role of specialized group management in the quality control of perioperative nursing.Methods:45 surgical nurses from our hospital were selected as the research subjects.Traditional operating room management was adopted from July 2019 to June 2020,and specialized group management was adopted from July 2020 to June 2021.The surgeon’s satisfaction,surgical nurses’core professional competence,and surgical patients’satisfaction were obtained through surveys and the results were analyzed.Results:Surgeon satisfaction before the implementation of specialized group management was significantly lower than after its implementation(P<0.05).Besides,surgical nurses’core professional competency scores before the implementation of specialized group management were significantly lower than after its implementation(P<0.05).Lastly,surgical patients’satisfaction before the implementation of specialized group management was significantly lower than after its implementation(P<0.05).Conclusion:Specialized group management helps to improve the quality of perioperative care and should be applied in clinical practice.

Bilateral choroidal ganglioneuroma:a comprehensive analysis of vision decline in a 6-year-old boy

Dear Editor,We write to present a 6-year-old boy with bilateral choroidal ganglioneuroma(CG)by comprehensive multimodal imaging(MMI)in a duration of 6-year follow-up.To our knowledge,this is the first case report with elaborate data to delineate the natural history of visual function and MMI in a boy with rare bilateral CG,confirmed by choroid biopsy.

Socio-scientific quantification of the comprehensive benefits of debris flow mitigation measures for villages in western Sichuan, China

Debris flow hazards seriously threaten thesafety and sustainable development of mountainousareas. Numerous debris flow mitigation measures havebeen implemented worldwide;however, acomprehensive assessment of the specific disasterreduction effects of these measures and their economic,social and ecological benefits is yet to be performed.The western region of Sichuan Province frequentlysuffers from geohazards such as debris flow, and thegovernment has adopted many mitigation measures.This study assessed the benefits of debris flowmitigation measures and identified the key influencingfactors via a field-based study conducted in 81 villagesin western Sichuan province, China. A framework forthe evaluation of the benefits of rural debris flowmitigation measures was constructed andquantitatively evaluated using a survey. Snowballsampling was performed to recruit 81 village leadersand 468 farmers. The results showed that managementand engineering measures were the main methodsused to mitigate debris flow;ecological measures wereauxiliary. The average satisfaction scores of farmers forthese three types of measures were 4.07, 3.90, and 3.56,respectively (as measured on a five-point Likert scale).In contrast, in terms of the benefits of these mitigationmeasures, only a small proportion of villages (11.11%)obtained a high level of comprehensive benefits fromthe debris flow mitigation measures, while the majority(88.89%) received medium to low-level benefits. Toimprove this situation, we further studied and foundthat the main factors that restricted villages fromachieving high-level comprehensive benefits were theunpredictable nature of debris flows, labour forceoutflow and remoteness. Effective control measures, agood economic environment and strong governmentassistance were reported as crucial factors forimproving these comprehensive benefits. This studyprovides socio-scientific references for decisionmakingon rural debris flow mitigation measures while keeping villages at the centre of economic development.

Attributes of Specialized Households'Resilience and Its Impact on Rural Industrial Advancement:A Case Study of National Musical Instrument Production Specialized Households in Lankao County,Henan,China

Specialized households serve as the primary units within specialized villages in China,and their capacity to withstand risks and external influences significantly shapes the future trajectory of specialized villages and the overall vitality of the rural economy.In this study,we established a measurement indicator system based on the definition of specialized households’resilience,elucidating the logical connection between specialized households’resilience and rural industrial development in China.The musical instrument industry in Lankao County,Henan Province of China,was employed as a case;survey data,the entropy method,and an obstacle diagnosis model were used to examine how instrument production specialized households responded to the challenges posed by Corona Virus Disease 2019(COVID-19)and the tightening of national environmental protection policies,yielding the following key findings:1)there exists substantial variation in the comprehensive resilience levels among different specialized households;2)the ability to learn and adapt is the most significant contributor to the overall resilience level of specialized households;3)technological proficiency and access to skilled talent emerge as pivotal factors influencing specialized households’resilience;4)the positioning of specialized households within the industrial supply chain and the stability of their income have a direct bearing on their resilience level.The influence of specialized households’resilience on industrial development primarily manifests in the following ways:stronger resilience correlates with increased stability in production and sales,fostering a more proactive approach to future actions.However,heightened exposure to the external macroeconomic environment can lead to a higher rate of export reduction.To enhance the development resilience of entities like specialized households and family farms,and to invigorate rural economic development,escalating investments in rural science and technology and prioritizing the training of technical talent become imperative.

The Oral Health Status of Person with Special Needs in Kumasi

Background: The most prevalent non-communicable disease worldwide is oral health-related disease, with dental caries and periodontal conditions being common. Oral health status significantly impacts overall health and quality of life. Barriers to dental care affect children with special needs. This study evaluates the oral health status and treatment requirements of people with special needs. Methodology: This descriptive cross-sectional study in Kumasi, Ghana examined oral health status among people, 121 children with special needs over two months, in June-July 2022. Dental caries, periodontal changes, malocclusion, and trauma were assessed. The data was analyzed using SPSS 20.0. Results: The oral health status among people with special needs in this study was generally moderate, with a range from very good to very poor. The prevalence of dental caries was 37%, with a mean DMFT score of 2.82. Periodontal health showed unsatisfactory indicators such as mobile teeth, poor gingival health, high plaque scores, and the presence of halitosis. Conclusion: This descriptive study aimed to provide baseline data on the oral health status of special needs students in Kumasi, addressing the lack of knowledge in this area. It highlighted the importance of dental care in maintaining good oral health and overall well-being in individuals with special needs. Coordinated efforts by dental professionals are needed to provide dental health education and preventive interventions for these children.

Strategies for improving crop comprehensive benefits via a decision-making system based on machine learning in the rice‒rape,rice‒wheat and rice‒garlic rotation systems in Southwest China

Rice‒rape,rice‒wheat and rice‒garlic rotations are common cropping systems in Southwest China,and they have played a significant role in ensuring ecological and economic benefits(EB)and addressing the challenges of China’s food security in the region.However,the crop yields in these rotation systems are 1.25‒14.73%lower in this region than the national averages.Intelligent decision-making with machine learning can analyze the key factors for obtaining better benefits,but it has rarely been used to enhance the probability of obtaining such benefits from rotations in Southwest China.Thus,we used a data-intensive approach to construct an intelligent decision‒making system with machine learning to provide strategies for improving the benefits of rice-rape,rice-wheat,and rice-garlic rotations in Southwest China.The results show that raising the yield and partial fertilizer productivity(PFP)by increasing seed input under high fertilizer application provided the optimal benefits with a 10%probability in the rice-garlic system.Obtaining high yields and greenhouse gas(GHG)emissions by increasing the N application and reducing the K application provided suboptimal benefits with an 8%probability in the rice-rape system.Reducing N and P to enhance PFP and yield provided optimal benefits with the lowest probability(8%)in the rice‒wheat system.Based on the predictive analysis of a random forest model,the optimal benefits were obtained with fertilization regimes by reducing N by 25%and increasing P and K by 8 and 74%,respectively,in the rice-garlic system,reducing N and K by 54 and by 36%,respectively,and increasing P by 38%in rice-rape system,and reducing N by 4%and increasing P and K by 65 and 23%in rice-wheat system.These strategies could be further optimized by 17‒34%for different benefits,and all of these measures can improve the effectiveness of the crop rotation systems to varying degrees.Overall,these findings provide insights into optimal agricultural inputs for higher benefits through an intelligent decision-making system with machine learning analysis in the rice-rape,rice‒wheat,and rice-garlic systems.

Nondestructive and active interrogation system for special nuclear material:proof of principle and initial results

Herein,we employ the threshold energy neutron analysis(TENA)technique to introduce the world's first active interrogation system to detect special nuclear materials(SNMs),including U-235 and Pu-239.The system utilizes a DD neutron generator based on inertial electrostatic confinement(IEC)to interrogate suspicious objects.To detect secondary neutrons produced during fission reactions induced in SNMs,a tensioned metastable fluid detector(TMFD)is employed.The current status of the system's development is reported in this paper,accompanied by the results from experiments conducted to detect 10 g of highly enriched uranium(HEU).Notably,the experimental findings demonstrate a distinct difference in the count rates of measurements with and without HEU.This difference in count rates surpasses two times the standard deviation,indicating a confidence level of more than 96% for identifying the presence of HEU.The paper presents and extensively discusses the proof-of-principle experimental results,along with the system's planned trajectory.

Empowering Rice Farmers in Nueva Ecija, Philippines: A Strategic Approach to Boosting Income through Special Purpose Rice Production

Low income is the main problem of millions of farmers who are cultivating 4.81 million hectares in the Philippines. This problem is attributed to challenges specifically low yield, low quality of produce, and significant post-harvest losses, particularly in a resource-scarce setting. This study aimed to help increase the farmers’ income in selected towns of Nueva Ecija through the promotion and use of special purpose rice production technology. Twenty (20) farmer-cooperators in three towns of Nueva Ecija were selected to demonstrate the production technology covering a total area of 4.75 hectares during the dry season, and 3.3 hectares during the wet season, both in 2023. Extension modalities such as training, techno-demo establishment, information material and technical assistance provision, and market linkage were undertaken to enhance their knowledge, attitude, and skills on special rice production and enterprise. The study utilized the descriptive quantitative method wherein the data were gathered through surveys, specifically personal interviews. Results showed that 70% of the farmer-cooperators were male and 60% were living below the poverty threshold. The farmers were 53 years old on average and engaged in farming as their primary source of income. The average yield of special purpose rice particularly the CLS-2 variety was higher (6.46 MT/ha and 6.22 MT/ha during dry and wet seasons, respectively) than that of inbred or non-special rice. The income per hectare from special purpose rice production per hectare was Php 75,420.00, which is higher than that of regular rice at Php 29,389.00, giving a higher benefit of Php 46,031.00. The technology adopters and area planted increased (from 6 to 9 and from 1.4 hectares to 2.75 hectares, respectively) in Licab, Nueva Ecija. The opposite was true in Sto. Domingo and Guimba, Nueva Ecija where farmers were discouraged by the marketing issues that arose.

Comprehensive reutilization of herbal waste:Coproduction of magnolol,honokiol,and β-amyrin from Magnolia officinalis residue

Herbal extraction residues(HERs)cause serious environmental pollution and resource waste.In this study,a novel green route was designed for the comprehensive reutilization of all components in HERs,taking Magnolia officinalis residues(MOR)as an example.The reluctant structure of MOR was first destroyed by alkali pretreatment to release the functional ingredients(magnolol and honokiol)originally remaining in MOR and to make MOR more accessible for hydrolysis.A metal–organic frame material MIL-101(Cr)with a maximum absorption capacity of 255.64 mg g^(-1)was synthesized to absorb the released honokiol and magnolol from the pretreated MOR solutions,and 40 g L^(-1)reducing sugars were obtained with 81.8%enzymatic hydrolysis rate at 10%MOR solid loading.Finally,382 mg L-1β-amyrin was produced from MOR hydrolysates by an engineered yeast strain.In total,1 kg honokiol,8 kg magnolol,and 7.64 kg β-amyrin could produce from 1 ton MOR by this cleaner process with a total economic output of 170,700 RMB.

Effect of comprehensive management combined with cognitive intervention on patient cooperation and complications during digestive endoscopy

BACKGROUND As lifestyles continue to change worldwide,the incidence of digestive tract carcinoma has gradually increased.Digestive endoscopy is an important tool that can assist in the diagnosis,treatment,and surgical intervention for this disease.However,the examination process is affected by many factors,and patient cooperation is often poor,which can increase the risk of complications.AIM To explore the effects of integrated management and cognitive intervention on cooperation and complications in patients undergoing endoscopy for early gastrointestinal neoplasms.METHODS A total of 354 patients with early stage gastrointestinal cancer who underwent digestive endoscopy procedures between January and December 2023 at our hospital were divided into observation and control groups(177 patients in each group)in a randomized controlled blind trial.The control group received routine interventions,while the observation group received comprehensive integrated management combined with cognitive interventions.We compared the changes in adverse mood,discomfort,examination time,cooperation with the examination,and complications before and after the intervention between the two groups.RESULTS The self-rated anxiety and depression scale scores were lower in the observation group than in the control group(P<0.05).The visual analog scale scores for discomfort during intubation and examination were also lower in the observation group than in the control group(P<0.05).Furthermore,the examination time was shorter in the observation group than in the control group(P<0.05),and the degree of cooperation(94.35%)was higher in the observation group than in the control group(84.75%;P<0.05).Lastly,the incidence rates of gastrointestinal adverse reactions(10.17%vs 20.34%),choking agitation(14.69%vs 24.86%),abdominal pain(8.47%vs 18.08%),and muscle tension(5.08%vs 14.12%)were all lower in the observation group than in the control group(P<0.05).CONCLUSION Integrated management and cognitive intervention in early gastrointestinal neoplasm endoscopy alleviate mood,reduce discomfort,shorten examinations,improve cooperation,and reduce complications.

Comprehensive analysis of gene mutations and mismatch repair in Chinese colorectal cancer patients

BACKGROUND RAS,BRAF,and mismatch repair(MMR)/microsatellite instability(MSI)are crucial biomarkers recommended by clinical practice guidelines for colorectal cancer(CRC).However,their characteristics and influencing factors in Chinese patients have not been thoroughly described.AIM To analyze the clinicopathological features of KRAS,NRAS,BRAF,and PIK3CA mutations and the DNA MMR status in CRC.METHODS We enrolled 2271 Chinese CRC patients at the China-Japan Friendship Hospital.MMR proteins were tested using immunohistochemical analysis,and the KRAS/NRAS/BRAF/PIK3CA mutations were determined using quantitative polymerase chain reaction.Microsatellite status was determined using an MSI detection kit.Statistical analyses were conducted using SPSS software and logistic regression.RESULTS The KRAS,NRAS,BRAF,and PIK3CA mutations were detected in 44.6%,3.4%,3.7%,and 3.9% of CRC patients,respectively.KRAS mutations were more likely to occur in patients with moderate-to-high differentiation.BRAF mutations were more likely to occur in patients with right-sided CRC,poorly differentiated,or no perineural invasion.Deficient MMR(dMMR)was detected in 7.9% of all patients and 16.8% of those with mucinous adenocarcinomas.KRAS,NRAS,BRAF,and PIK3CA mutations were detected in 29.6%,1.1%,8.1%,and 22.3% of patients with dMMR,respectively.The dMMR was more likely to occur in patients with a family history of CRC,aged<50 years,right-sided CRC,poorly differentiated histology,no perineural invasion,and with carcinoma in situ,stage I,or stage II tumors.CONCLUSION This study analyzed the molecular profiles of KRAS,NRAS,BRAF,PIK3CA,and MMR/MSI in CRC,identifying key influencing factors,with implications for clinical management of CRC.

Risk factors for secondary infection after liver failure and effect of comprehensive nursing intervention

BACKGROUND In patients with liver failure(LF),the high rate of secondary infections,which are associated with poor prognosis,highlights the clinical significance of understanding the underlying risk factors and implementing targeted intervention programs.AIM To investigate risk factors for secondary infections in patients with LF and evaluate the effectiveness of comprehensive nursing interventions.METHODS This retrospective study included 64 patients with LF,including 32 with and 32 without secondary infections.A questionnaire was used to collect data on age;laboratory parameters,including total and direct bilirubin,prothrombin time,blood ammonia,and other biochemical parameters;invasive procedures;and complications.Patients with secondary infections received comprehensive nursing intervention in addition to routine nursing care,whereas those without secondary infections received only routine nursing care to compare the effect of nursing intervention on outcomes.RESULTS The infection rate,which was not associated with age or complications,was significantly associated with biochemical parameters and invasive procedures(P<0.05).The infection rate was 61.6%in patients who had undergone invasive procedures and 32.1%in those who had not undergone invasive procedures during the hospital stay.The infection rate was also significantly associated with the type of LF(P<0.05),with the lowest rate observed in patients with acute LF and the highest rate observed in those with subacute LF.The nursing satisfaction rate was 58.3%in the uninfected group and 91.7%in the infected group,indicating significantly higher satisfaction in the infected group(P<0.05).CONCLUSION In patients with LF,the rate of secondary infections was high and associated with biochemical parameters and type of LF.Comprehensive nursing intervention can improve patient satisfaction.