Clinical decision support system is a system that utilizes models or knowledge bases to assist clinical decision-making through human-computer interaction for semi-structured or unstructured clinical problems, with the aim of reducing decision-making errors among medical staff and improving the quality of medical and nursing services. In recent years, clinical decision support system has attracted wide attention in the field of clinical nursing of Traditional Chinese Medicine. This paper will review the development status, application advantages and existing problems of clinical decision support system in the field of clinical nursing of Traditional Chinese Medicine, aiming to provide reference for the development of a more specialized and systematic clinical decision support system for clinical nursing of Traditional Chinese Medicine.

Objective To establish a scientific and systematic quality evaluation system for the implementation of TCM nursing programs,and to provide references for promoting the standardized implementation and quality improvement of TCM nursing programs.Methods From October 2023 to December 2023,a research team was set up to form the first draft of the quality evaluation system for the implementation of TCM nursing programs based on the"structure-process-results"three-dimensional quality model,by combining literature research and focus group interviews,and the quality evaluation system for the implementation of TCM nursing programs was formulated by means of Delphi expert letter consultation and analytic hierarchy process.Results 2 rounds of professional consultations resulted in an excellent recovery rate of 100％;the expert authority coefficients were 0.853 and 0.958;the Kendall harmony coefficients of expert opinions were 0.151 and 0.152,respectively.Finally,the quality evaluation system of TCM nursing program implementation was determined,including 3 first-level indicators,including structure,process and result.There are 6 secondary indicators,including system management,implementation management,quality management,effect evaluation,safety evaluation,and satisfaction evaluation.There are 18 three-level indicators,including the implementation management system of TCM nursing program and regular optimization of TCM nursing program.Conclusion The quality evaluation system for the implementation of TCM nursing programs is scientific and reliable,but its practicability needs to be tested in clinical practice.

Objective:To systematically evaluate the effect of virtual reality technology in postoperative rehabilitation of patients with total knee and hip arthroplasty replacement.Methods:Randomized controlled trials of the effect of virtual reality technology in postoperative rehabilitation of patients with total knee and hip arthroplasty replacement were searched through PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, CBM, VIP and Wanfang data.The retrieval period was from the establishment of database to November 25, 2021. Literature screening, information extraction and quality evaluation were conducted by 2 researchers. RevMan 5.4 software was used for Meta-analysis.Results:A total of 9 literatures and 668 patients were included. The Meta-analysisresults showed that virtual reality technology compared with traditional rehabilitation methods could reduce pain score ( MD=-0.64, 95% CI: -0.86--0.42, P<0.001), improve joint function ( MD=-4.46, 95% CI: -5.85--3.07, P<0.001; MD=9.78, 95% CI: 6.61-12.95, P<0.001; SMD=1.84, 95% CI: 0.85-2.83, P<0.001), increase joint range of motion ( MD=7.25, 95% CI: 6.48-8.02, P<0.001), improve patient's balance function ( MD=6.20, 95% CI: 5.01-7.38, P<0.001) and quality of life ( SMD=1.30, 95% CI: 0.90-1.71, P<0.001) . Conclusions:Virtual reality technology can improve joint function, range of motion, balance function and quality of life of patients with total knee and hip arthroplastyreplacement, reduce pain scores. However, the existing evidence cannot prove the effect of virtual reality technology on psychological function, enthusiasm and interest of patients, and further discussion is needed in the future.

Objective:To investigate the roles of N6-methyladenosine (m 6A) modification in regulating RP11-426A6.5 in the development of laryngeal squamous cell carcinoma (LSCC). Methods:The methylation and expression levels of lncRNAs were identified and important lncRNAs were screened utilizing long non-coding RNA (lncRNA) m 6A methylation microarray. Cancer and para cancer tissue samples were taken from 48 LSCC patients hospitalized to the Department of Otolaryngology-Head and Neck Surgery of the Second Affiliated Hospital of Harbin Medical University between January and September 2017. Expression profiling microarray was performed in 3 of 48 LSCC samples, and methylated RNA immunoprecipitation-quantitative PCR (MeRIP-qPCR) and quantitative real-time fluorescent PCR (qRT-PCR) were performed in the remaining 45 LSCC samples to verify the m 6A modification and expression levels of RP11-426A6.5. Correlations between RP11-426A6.5 and clinical factors were anlysed. Laryngeal cancer cell line with low expression of RP11-426A6.5 was created in vitro using RNA interference (RNAi) technology. The 5-Ethynyl-2′-deoxyuridine (EdU) cell proliferation experiment, wound healing experiment, and transwell invasion experiment were used respectively to measure the proliferation, migration, and invasion of LSCC cells. The effect of RP11-426A6.5 down-regulation on the growth of transplanted tumors in vivo was verified by nude mice tumorigenesis assay. The Cancer Genome Atlas (TCGA) database and sequence-based RNA adenosine methylation site predictor (SRAMP) website were used to predict the enzymes and corresponding methylation sites. MazF digestion was chosen to validate the binding sites. RNAi technology was used to observe the changes in cell function after interfering with the expression of the corresponding genes of the modified enzymes. MeRIP-qPCR was used to detect the level of RP11-426A6.5 m 6A cell line treated with actinomycin D was used to observe the stability of RP11-426A6.5. Results:RP11-426A6.5 methylation and expression levels were significantly higher in LSCC tissues than those in paracancerous tissues (methylation levels: 23.828±4.975 vs 20.280±3.607; expression levels: 1.197±0.314 vs 1.015±0.170, all P values<0.05). RP11-426A6.5 expression levels were closely correlated with T stage (T1-2: 1.081±0.298 vs T3-4: 1.306±0.292, χ 2=5.35, P<0.05). The postoperative survival of patients with high RP11-426A6.5 expressions was significantly lower than that of patients with low RP11-426A6.5 expression ( P=0.046). Assays in vitro and in vivo showed that the downregulation of RP11-426A6.5 significantly decreased the proliferation, migration, and invasion abilities of LSCC cells and the growth of transplanted tumors. The binding of methyltransferase-like 3 (METTL3), an m 6A-modified enzyme, to the corresponding methylation site of RP11-426A6.5 enhanced its stability and mediated its regulation of malignant behaviors of LSCC cells. Conclusions:RP11-426A6.5 can regulate the malignant behaviors of LSCC cells, which is mediated by the m 6A modification process involving in the methyltransferase METTL3.

Objective:To construct a Traditional Chinese Medicine (TCM) nursing training system for nurses with medium-grade professional title in TCM hospitals based on Kirkpatrick model, so as to provide a reference for the training of nurses with medium-grade professional title in TCM hospitals.Methods:Based on the Kirkpatrick model, combined with the results of literature review, questionnaire survey and semi-structured interviews, the first draft of the training system was formulated and the expert consultation questionnaire was prepared. A total of 21 experts from Zhejiang Province were selected for 2 rounds of expert correspondence.Results:The questionnaire recovery rate of the two rounds of expert correspondence was 100%. The expert authority coefficients were 0.89 and 0.91, and the Kendall's W were 0.239 and 0.176 ( P<0.001) . The final training system included 3 first-level indicators, 11 second-level indicators, 37 third-level indicators and 145 fourth-level indicators. Conclusions:The construction method of the TCM nursing training system for nurses with medium-grade professional title is scientific and the content is reasonable and comprehensive, which can provide a scientific reference for the training of nurses with medium-grade professional title in TCM hospitals.

Objective:To construct a color assessment tool for continuous bladder irrigation (CBI) drainage fluid and to explore its clinical value.Methods:The color assessment tool for CBI drainage fluid (tentative version) was constructed through literature review, expert meetings and practical development, and its consistency was tested and the tool was improved to form a color assessment tool for CBI drainage fluid. Convenience sampling was used to select patients with benign prostatic hyperplasia who underwent transurethral resection of the prostate (TURP) in the First Affiliated Hospital of Soochow University from April to May 2020. According to the assessment method of the tool, the patient's drainage fluid color was evaluated and recorded.Results:The color assessment tool for CBI drainage fluid included 6 color scales, and the corresponding Pantone color card codes were 503C, 3519C, 701C, 702C, 710C, 1807C respectively, and the blood concentration was 0.125%, 0.5%, 1.0%, 2.0%, 4.0% and 8.0% respectively. The tool was used to evaluate the drainage fluid color in 29 patients after TURP. Each evaluation took (5.12±2.41) s; when the color scale was greater than number two, complications such as the bladder spasm and blood clot blockage occurred.Conclusions:The construction method of color assessment tool for CBI drainage fluid is scientific and reliable, which can provide a basis for evaluating the CBI drainage fluid color, and can assist medical and nursing staff to quickly evaluate the drainage fluid color and find abnormal color scales.

Objectives To evaluate the values of notched on R wave in inferior leads of electrocardiogram in infant with secundum atrial septal defect. Methods To observe and compare the prevalence of notch on R wave in inferior leads combined with incomplete right bundle branch block (IRBBB) in 162 cases with secundum atrial septal defect (group I) and 162 cases without heart disease (group II). Results The prevalence of notch on R wave in all the three inferior leads, in at least one inferior lead with IRBBB and in all the three inferior leads with IRBBB were 27.16%, 14.20%and 10.49%respec-tively in group I, and were 3.09%, 1.85%and 0.62%in group II respectively, and the differences between two groups were statistically significant (P<0.005). The specificities of notch on R wave in diagnosis of atrial septal defect were 96.91%, 98.15% and 99.38% respectively. Conclusions Notch on R wave in inferior leads is an independent electrocardiographic sign of secundum atrial septal defect in infants, and thus can be used as a diagnostic parameter.

Objectives To evaluate the clinical value of heart rate variability (HRV) analysis in school-age healthy chil-dren with functional ST-T changes in electrocardiogram (ECG). Methods In 143 school-age children (50 cases of functional ST-T changes, 43 cases of myocarditis children with ST-T change, 50 cases of healthy controls without ST-T changes), HRV time domain value was measured in three groups with 24 dynamic electrocardiogram. Results Compared with healthy controls, PNN50, rMSSD and SDSD were decreased while the heart rate, SDNN and SDANN were increased in children with functional ST-T changes (P all<0.05). Meanwhile, compared with children with functional ST-T changes and healthy controls, the heart rate was increased while PNN50, rMSSD, SDSD, SDNN and SDANN were decreased in the myocarditis children with ST-T change (P<0.05). Conclusions The autonomic nervous system of school-age children is not stable. The functional ST-T changes are related with the imbalance between sympathetic and vagus nerve activities. HRV analysis has important diagnostic signifi-cance in the functional ST-T changes.

Objective To explore the relationship between 5-minute Apgar score and heart rate variability (HRV) in severely asphyxiated neonates. Methods A total of 103 severely asphyxiated neonates with 1-minute Apgar score of 0 to 3 points were selected. They were divided into Group A (>7 points, n=50) and Group B (≤7 points, n=53) based on 5-minute Apgar score. Meanwhile, 40 full-term neonates with 1-and 5-minute Apgar score greater than 7 points were selected as control group. 24-hour dynamic electrocardiogram was performed and HRV was analyzed on the third day after birth in three groups. Results PNN50, rMSSD, SDSD were decreased and SDNN, SDANN were increased in group B as compared with group A and control group (P<0.05). No signiifcant difference of HRV was observed between group A and control group (P>0.05). Conclusions Neonatal asphyxia can cause damage to autonomic nervous system. 5-minute Apgar score and HRV can be joint-ly used as a non-invasive index in autonomic nervous damage and its prognosis in asphyxiated newborns.

This article studies the thermostability and the crystal structure of a new anticancer drug dasatinib. The thermostability of dasatinib was analyzed using the differential scanning calorimeter (DSC) and thermo gravimetric analyzer (TGA), and the structural characteristics of polymorphism and crystalline transformation was determined using the X-ray powder diffractometry (XRD) with in-situ high temperature accessories. The results showed that dasatinib has at least two different crystal forms. The form-I has one crystalline water and form-II one and half, and in a heating-up processing both of them would change their crystal structures. After losing their crystalline water, both would change into the same crystalline form with no crystalline water. Their melting points were almost the same: form-I was 285.68 degrees C and form-II was 285.50 degrees C. The results of the study method would provide a comprehensive reference for the quality evaluation of dasatinib.