Objective:To explore the specialty work engagement dilemma among wound therapists in non-specialist clinics, so as to provide a reference basis for improving wound therapists' work engagement and reducing job burnout.Methods:This study was a phenomenological study. Semi-structured interviews with 12 wound therapists in non-specialist clinics from 12 hospitals were conducted between May and July 2024 using purposive sampling. Colaizzi seven-step method was used for data analysis and topic refinement.Results:A total of five themes and 13 sub-themes were extracted, including the role change dilemma (focus dispersion due to transfer of positions in clinical departments, and identity challenges due to adjustment of the field of job posting) , career development dilemma (reduced motivation due to obstacles to in-depth development in specialized fields, and limited conditions for scientific research training and implementation impeding the recognition and return of work) , support environment dilemma (insufficient medical insurance support increased job burden, lack of hospital support reduced work efficiency, lack of team support weakened work focus, poor self-support limited the depth of work engagement, lack of support from patients and their families increased the difficulty of maintaining work motivation) , pros and cons weighing dilemma (unclear delineation of risk and responsibility, difficult to weigh risk and benefit) , dilemma of whole-course management of disease (lack of communication between hospitals weakened the continuity of work, lack of home follow-up increased the uncertainty of the work) .Conclusions:Specialty work engagement dilemmas among wound therapists in non-specialist clinics are influenced by a variety of factors. It is necessary for medical institutions, healthcare workers and patients' families to work together to create a favorable working environment for wound therapists in order to promote the high-quality development of wound therapy nursing services in China.

Psychological factors have become significant contributors to the onset and progression of insomnia. This article explored the treatment of insomnia from the perspective of “liver governs wei qi （defensive qi）”. The concept of “liver governs wei qi （defensive qi）” is summarized in three aspects， firstly， the liver assists the spleen and stomach in transformation and transportation， governing the generation of wei qi； secondly， the liver aids lung qi diffusion and dispersion， governing the distribution of wei qi； thirdly， the liver regulates circadian rhythms， governing the circulation of wei qi. It is proposed that the clinical treatment of insomnia should focus on the following methods： for regulating the liver to harmonize the five viscera， and facilitate the circulation of wei qi， medicinals entering the liver channel include Chaihu （Bupleuri radix）， Baishao （Paeoniae Radix Alba）， Zhizi （Gardeniae Fructus）， and Suanzaoren （Ziziphi Spinosae Semen） could be commonly used； for nourishing the liver， the treatment should align with the day-night rhythm， and herbs such as Baihe （Lilium）， Hehuan （Albizia julibrissin）， and Yejiaoteng （Polygoni multiflori caulis） are commonly used； for soothing the liver and address both mental and physical health to calm wei qi， treatment should advocate verbal counseling， psychological regulation， and health education. Ultimately， this treatment approach can free liver qi to flow， soothe qi movement， restore the motion of wei qi， regulate during day and night， balance yin and yang， and resolve insomnia effectively.

Objective:To explore the specialty work engagement dilemma among wound therapists in non-specialist clinics, so as to provide a reference basis for improving wound therapists' work engagement and reducing job burnout.Methods:This study was a phenomenological study. Semi-structured interviews with 12 wound therapists in non-specialist clinics from 12 hospitals were conducted between May and July 2024 using purposive sampling. Colaizzi seven-step method was used for data analysis and topic refinement.Results:A total of five themes and 13 sub-themes were extracted, including the role change dilemma (focus dispersion due to transfer of positions in clinical departments, and identity challenges due to adjustment of the field of job posting) , career development dilemma (reduced motivation due to obstacles to in-depth development in specialized fields, and limited conditions for scientific research training and implementation impeding the recognition and return of work) , support environment dilemma (insufficient medical insurance support increased job burden, lack of hospital support reduced work efficiency, lack of team support weakened work focus, poor self-support limited the depth of work engagement, lack of support from patients and their families increased the difficulty of maintaining work motivation) , pros and cons weighing dilemma (unclear delineation of risk and responsibility, difficult to weigh risk and benefit) , dilemma of whole-course management of disease (lack of communication between hospitals weakened the continuity of work, lack of home follow-up increased the uncertainty of the work) .Conclusions:Specialty work engagement dilemmas among wound therapists in non-specialist clinics are influenced by a variety of factors. It is necessary for medical institutions, healthcare workers and patients' families to work together to create a favorable working environment for wound therapists in order to promote the high-quality development of wound therapy nursing services in China.

In recent years, the third medical education reform characterized by competency-based medical education (CBME) is being carried out around the world; however, there are still challenges in bridging competency framework with clinical practice during implementation. With reference to the three-step method for constructing a CBME curriculum system based on entrustable professional activities (EPAs) and related policies and studies in China in recent years, this article constructs a framework of EPAs with the features of orthopedics by detailing the EPAs of specified clinical operation. On this basis, this article proposes a competency-oriented standardized training system for orthopedic residents, with the help of teaching evaluation methods to ensure the successful implementation of courses, so as to provide a reference for establishing a training system for surgery based on EPAs.

Objective To develop a virtual reality rehabilitation support system and evaluate its effects on improving discharge readiness in caregivers of laryngectomy patients.Methods The system is equipped with a virtual reality-based home nursing skills guidance module for post-laryngectomy patients and an evidence-based artificial intelligence Q&A module.A convenience sampling method was adopted to select 64 caregivers of patients who underwent laryngectomy for the first time in the otorhinolaryngology head and neck surgery department of a tertiary A hospital in Beijing from July 2024 to January 2025 for a systematic study on application effects.To avoid cross-contamination between an experimental group and a control group,ward-based grouping was applied.A coin toss was used to assign Ward 1 to an experimental group and Ward 2 to a control group,with 32 cases in each group.The experimental group received discharge guidance based on the virtual reality technology,while the control group was provided with conventional verbal and written discharge instructions.The readiness for hospital discharge and the quality of discharge teaching scores of caregivers were compared between the 2 groups after the intervention.Results No sample detachment.After the intervention,the patient caregivers in the experimental group scored significantly higher than those in the control group in terms of discharge readiness and quality of discharge guidance,with a statistically significant difference(P＜0.001).Conclusion This study developed the virtual reality rehabilitation system for laryngeal cancer patients demonstrated good feasibility and effectiveness.The application of this system for discharge education significantly improved discharge readiness of caregivers and quality of discharge guidance for post-laryngectomy patients.It also helped with the optimization of health education models,enhancement of nursing resource utilization efficiency,and improvement of transitional care.

[Objective]To investigate the etiology and pathological mechanisms of prediabetes based on the theory of"excessive earth stagnation,"thereby expanding novel therapeutic approaches for prediabetes management.[Methods]Integrating classical Chinese medical literature with contemporary clinical insights,this study elucidates the correlation between Dunfu(thickened stagnation)and excessive earth stagnation and its pivotal role in prediabetes pathogenesis,and proposes the therapeutic strategies.[Results]The Dunfu mechanism documented in The Inner Canon of the Yellow Emperor demonstrates significant correlation with the"spleen-earth stagnation"pathological state in prediabetes,which primarily disrupts the ascending-descending dynamic of Qi in middle-Jiao and contributes to glucose metabolism dysregulation.Dunfu(thickened stagnation)acts as a quintessential manifestation of excessive earth stagnation.When Dunfu develops,damp-heat pathogens accumulate,causing retention of food essence and further aggravating earth stagnation,the retained food and essence transforming into dampness,heat and phlegm.These turbid pathogens obstruct the middle-Jiao,impairing spleen function and Qi-blood flow,eventually generating heat that scorches the Zang-Fu organs.This progression from Pidan to Xiaodan underscores Dunfu as the root pathology.Treatment should prioritize resolving stagnation,clearing heat and eliminating turbidity,with tailored Zang-Fu syndrome differentiation to restore Beihua(preparation and transformation).[Conclusion]"Excessive earth stagnation"is the core pathological mechanisms of prediabetes,leading to retention of food essence and further aggravation earth stagnation,and the treatment should prioritize resolving stagnation.Treating prediabetes based on"excessive earth stagnation"has clinical guidance significance.

Objective To explore the distribution of common TCM syndromes and symptoms of insomnia;To prepare for the construction of the theoretical framework and item pool of syndrome diagnosis and efficacy evaluation scale.Methods TCM guideline standards of insomnia,textbooks and journals over the years were retrieved,the information of TCM syndromes,syndrome elements and symptoms was extracted,the guideline textbook and journal database were established,and descriptive statistics,association rules,systematic clustering,factor analysis,potential categories and implicit structure analysis were carried out.Results Totally 116 guide standards and textbooks over the years were included,and 454 articles of journals were included.The high-frequency symptoms accounted for≥3%of the guide textbooks and journal databases were 87 and 79 categories,respectively,and the cumulative proportion was 87.48%and 87.75%,respectively.According to the analysis results,five common TCM syndromes and their characteristic symptom classification of insomnia were finally deduced.According to the frequency/person time distribution,they were heart and spleen deficiency syndrome,yin deficiency and fire hyperactivity syndrome,liver fire disturbing heart syndrome,phlegm heat disturbing heart syndrome,heart and gallbladder qi deficiency syndrome.Conclusion There are five common TCM syndromes of insomnia,and the characteristic symptoms of each TCM syndrome provide a reference source for the theoretical framework of syndrome diagnosis and efficacy evaluation scale and the establishment of item pool.

Objective:To explore the evolution process of coping styles in patients with keloids.Methods:A purposive sampling method was used to select 35 keloid patients from the Department of Plastic Surgery, Peking Union Medical College Hospital from August 2022 to May 2024. The cohort included 13 males and 22 females, aged 12-66 (35.1±3.5) years. Semi-structured interviews were conducted with the patients based on the self-depletion theory, and themes were extracted to construct a theoretical framework.Results:During the course of keloid disease, the initiating factors leading to maladaptive coping styles in patients included symptom distress, body image disturbance, lack of support, and excessive family reactions. Under the influence of these initiating factors, patients exhibited impairments in cognition, emotion, and attention control, followed by impulsive decision-making, negative emotions and avoidance, as well as diminished willpower and submission, ultimately resulting in maladaptive coping styles.Conclusions:Maladaptive coping styles in patients with keloids are a self-depletion process triggered by multiple factors. Intervening at the cognitive, emotional, and attention control levels can help patients develop effective coping styles for their condition.

Objective:To analyze the therapeutic efficacy and long-term outcomes of wire-assisted dynamic traction with corrective device for congenital nipple inversion.Methods:A retrospective study was conducted on 22 female patients (42 nipples) with congenital nipple inversion treated at the Department of Plastic Surgery, Peking Union Medical College Hospital from January to December 2017. The patients′ age was 18-54 (27.6±1.9) years. All patients underwent wire-assisted dynamic traction correction. Postoperative indicators including numerical rating scale (NRS) pain scores, nipple skin microcirculatory disorders, and traction duration were recorded. Follow-up assessments via telephone interviews were completed by September 20, 2022; mean follow-up time was (63.68±3.73) months. Evaluating questions included nipple retraction, fertility status and breastfeeding outcomes.Results:Pain in the operative area was non-radiating, and the pain level decreased over time. Mean NRS were (5.4±1.5) scores on surgery day, decreasing to (4.4±1.2) scores at postoperative day 1 and (3.3±1.7) scores at day 2. Microcirculatory assessments revealed Grade 0-I (intact skin) in 78.6% (33/42), Grade II (skin ulceration) in 14.3% (6/42), and Grade III (partial necrosis) in 7.1% (3/42) of the nipples, with no Grade IV necrosis observed. Successful device placement was achieved in all cases (42/42), with traction duration ranging 6-15 (9.6±0.6) months. Follow-up data from 12 patients (23 nipples) showed mild retraction in 3 nipples. Three patients subsequently delivered infants and successfully achieved breastfeeding.Conclusion:The wire-assisted dynamic traction method with corrective device demonstrates satisfactory therapeutic outcomes for congenital nipple inversion patients with favorable long-term maintenance and breastfeeding compatibility.

Triple-negative breast cancer(TNBC)is a highly aggressive and prognostically unfavorable subtype.Tertiary lymphoid structure(TLS)within the tumor microenvironment,comprising dendritic cells,B cells,T cells,and other immune cells,modulate the tumor immune response.The heterogeneity of TLS in TNBC,such as density,structural maturity,and molecular expression patterns,affects the tumor immune microenvironment and,consequently,treatment responses and clinical outcomes.Studies indicate a positive correlation between the density and maturity of TLS and the pathological complete response(pCR)of TNBC patients,with TLS enhancing the quantity of tumor-infiltrating immune cells and improving anti-tumor immune responses,thereby increasing sensitivity to chemotherapy and immunotherapy.Recent research has found that mature TLS are associated with effective immune responses,becoming significant predictors of treatment response.The combination of TLS with immune checkpoint inhibitors has shown promising prospects.Research demonstrates that promoting the formation or enhancing the functionality of TLS can improve anti-tumor immune effects and enhance treatment outcomes for TNBC patients.Targeting TLS may reduce immune evasion and increase the sensitivity to immunotherapy.However,clinical application of TLS still faces challenges,particularly the impact of their heterogeneity on treatment response.Current assessment methods for TLS are not standardized,lacking a uniform standard and diagnostic system,which limits their widespread application.Future research should focus on resolving these issues by developing standardized assessment tools and further exploring the role of TLS in immune escape and resistance mechanisms.This review aimed to summarize and analyze the existing research progress on TLS in TNBC,in order to provide new ideas for the development of personalized immunotherapy strategies.