Objective To reduce the energy consumption and cost of steam sterilizers at sterile supply centers .Methods Routine data of the steam sterilizers from January to June of 2016 were collected from one hospital in Changchun .Usage by timeframe of these sterilizers was analyzed , including their performance when they are powered on , standby (idle), and powered off and their energy expenditure at such states .Sustainable and stepwise energy saving strategy was developed , with the reduction of standby ( idle) period and energy saving amount of energy and cost .Results Usage of sterilizers was found with obvious peak and valley hours , while their standby hours during the latter were long and in a few timeframes . After implementation of the energy saving management strategy , their standby hours at various timeframes averaged ≤3 h (P<0.001).For six months, we reduced 5818 hours of standby time, 97 tons of steam, 2910 kW · h of electricity , saving cost over 30000 yuan ( 17％) .Conclusions The energy-saving management strategy could reduce the consumption of energy and cost effectively .

Objective:To investigate the clinical effect of the anterolateral thigh perforator chimeric flap in the treatment of the wound of diabetic foot ulcer (DFU) .Methods:From January, 2018 to December, 2019, 14 cases wound of DFU of type II diabetic were treated by anterolateral thigh chimeric perforator flap. The patients were 10 males and 4 females, at 49 to 58 years old. Of the 14 patients, 10 with simple peripheral neuropathy, 4 with peripheral neuropathy complicated with vascular disease, and none with single vascular disease. With strict control of patients' blood glucose, antibiotics blended bone cement was applied or filled onto grade 2 or higher grade Wagner's DFU after debridement. In addition, the anterolateral thigh chimeric perforator flap was transferred 2 to 3 weeks later. The size of flap was 8 cm×3 cm-27 cm×7 cm. Regular followed-up were made after surgery.Results:Thirteen flaps survived in one stage after surgery. The other 1 flap had venous vascular crisis, and survived completely after active exploration. The patients were followed-up for 6-12 months. All the flaps survived well in good shape and texture. The donor and recipient areas healed well. The functional recoveries of the DF were satisfactory.Conclusion:Application of anterolateral thigh perforator chimeric flap in repair of the refractory wound of DF achieves a good clinical outcome and effectively improves the life quality of patients.

Objective To explore expression and clinical significance of Cyclin E, p27 and Ki-67 proteins in patients with intracranial tumors. Methods All 46 cases of patients with intracranial tumor as tumor groups,normal brain tissues adjacent to intracranial tumor tissues as control groups. These samples were detected for the expression of Cyc lin E,p27,and Ki-67 by immune histochemical method(IHC)method. Positive rates of the three proteins in two groups,and the relationship between expressions of the proteins and pathological features of intracranial tumors were analyzed in this study. Results Cyclin E and Ki-67 expressions in tumor tissues were significantly higher than those in the control group(P<0.05),but p27 expression in tumor tissues was lower than the control groups (P<0.05). Cyclin E and Ki-67 positive rates in malignant tumor patients and the Ⅲ~Ⅳ grades with high deterioration were notably higher than those in benign tumors andⅠ~IIgrade with lower deterioration(P<0.05),p27 expression rates were lower andⅠ~IIat lower deterioration of benign tumors(P<0.05). Conclusion Higher expressions of Cyclin E and Ki-67,and low expression of p27 may be important factors involved in the occurrence and development of intracranial tumors, and positive expres-sions of Cyclin E,p27 and Ki-67 are related to the features and degree of differentiation of the intracranial tumors.

Objective To explore a simplified method of coagulation test for the individuals with erythrocytosis. Methods The antico-agulants, blood volume and fixed blood collecting volume were adjusted by the formula: anticoagulants (mL)＝(100－HCT×100)× blood (mL)×0.001 85. A total of 124 blood samples for coagulation testing in which the calcium ( Ca2+) interval was designated and hematocrit (HCT) was more than 55% were tested with calibrated anticoagulants, adjusted blood volume and fixed blood collection vol-ume [anticoagulant(mL)/0.055 5]. The results of plasma prothrombin time (PT), international standardization ratio (INR) and acti-vated partial thromboplastin time (APTT) before and after adjustment were compared. The results of the samples from 3 groups after adjustment were also compared. The relationship of HCT with unadjusted PT and APTT were simultaneously observed. Results The unadjusted results of PT, INR and APTT were significantly higher than those after anticoagulants adjustment (27.52±16.37 vs 12.49± 1.35, 2.31±1.47 vs 0.99±0.11 and 50.09±13.32 vs 33.37±5.05) with statistically significant difference in paired comparison (P＜0.05). No statistical difference was found in the comparison of the results for PT, INR and APTT after adjustment within the 3 groups ( PT: 12.49±1.35 vs 12.84±1.54 vs 12.82±1.76, INR:0.99±0.11 vs 1.02±0.13 vs 1.02±0.15, APTT: 33.37±5.05 vs 33.49±5.09 vs 32.83±5.06) (P＞0.05). HCT values of the patients were positively correlated with unadjusted PT (r＝0.461, P＜0.05) and APTT (r＝0.571, P＜0.05). Conclusion The coagulation test of the individuals with erythrocytosis may use to adjust the blood volume and the fixed blood collection volume provided calcium concentration in reference interval.

Objective:To investigate the changes of different cytokines in systemic juvenile idiopathic arthritis（SJIA）and their role in early diagnosis.Methods:A retrospective study was conducted to select pediatric patients with fever accompanied by elevated levels of CRP，erythrocyte sedimentation rate（ESR），and ferritin who visited the Department of Renal Immunology，Children's Hospital of Soochow University from November 2019 to January 2023.Compare the differences in CRP，ESR，ferritin，and 34 plasma cytokines levels between children with SJIA and other autoimmune diseases.Cytokine risk was analyzed by regression；Correlation analysis was performed to determine whether cytokines were associated with lymphocyte subsets and disease activity.Results:During the study period，118 children with fever accompanied by elevated CRP，ESR and ferritin were eligible，among whom 20 children with SJIA were diagnosed，and 98 children with other autoimmune diseases were diagnosed.There was no statistically significant difference in CRP and ESR between SJIA patients and children with other autoimmune diseases（Z values were 0.721 and 0.345，all P>0.05）；There were significant differences in ferritin，IL-27，IL-17A，IL-31，IFN-γ，IL-18 between children with SJIA and those with other autoimmune diseases（Z values were 2.628，-2.052，-2.763，-2.135，4.067，4.419，all P<0.05）.Univariate Logistic regression analysis showed that IL-18（ OR=1.003，95% CI：1.002~1.004， P<0.001），IFN-γ（ OR=1.004，95% CI：1.001~1.007， P=0.004），IL-27（ OR=0.846，95% CI：0.716~0.999， P=0.049），IL-31（ OR=0.657，95% CI：0.451~0.959， P=0.028）were closely related to the occurrence of SJIA，and stepwise Logistic regression analysis indicated that the increase of IL-18（ OR=1.005，95% CI：1.003~1.009， P=0.004）increased the risk of SJIA，and the increase of IL-5（ OR=0.619，95% CI：0.402~0.953， P=0.029）decreased the risk.IL-18（ r=0.673， P=0.020），IL-27（ r=0.486， P=0.041）and TNF-α（ r=0.560， P=0.016）were positively correlated with the activity of SJIA. Conclusion:IL-18 presents a characteristic cytokine positively correlated with the risk of SJIA，while IL-5 presents a protective cytokine against SJIA.Both cytokines have independent predictive power for the risk.

This article reviewed the concept,measuring methods,theoretical models and research progress of career resilience by retrieving and analyzing related literature at home and abroad. Besides,this paper also introduced its application in nursing management at home and abroad so as to provide the basis for nursing human resource management of China.

Objective:Medical post-doctors are important young talents in the field of medical research, to whom the management and training play an important roles in promoting the development of medical research. To improve the academic capacity and training quality of medical post-doctor, this article analyzed the status and problems of post-doctor management, and put forward countermeasures in a grade A tertiary pubic hospital in Beijing.Methods:Questionnaire survey and in-depth interview were used to survey the source, training mode, stress and satisfaction among 17 postdocs from 2016 to 2020.Results:The source of postdocs was limited, and there were a few interdisciplinary postdocs. After scientific research training, many postdocs can significantly improve their scientific research capacity; Most of the postdocs were under great pressure, which is mainly caused by scientific research and economic pressure. Key disciplines and cooperative supervisors are scientific research talents, which have high academic requirements for postdocs. Most postdocs are satisfied with their salary. Cooperative supervisors generally give full play to scientific research and clinical guidance, but lack of mental health guidance; Most postdocs have a low sense of belonging.Conclusions:The article proposed following measurements, including intensity propaganda, strengthen three-level management, enhance the sense of belonging, strengthen the management of cooperative supervisors, pay more attention to psychological counseling, relieve pressure, to improve the scientific research capacity and quality of medical postdocs.

Objective:To explore the current situation of nurses' turnover intention and its influencing factors based on the intergenerational differences, analyze the similarities and differences.Methods:From January to March 2018, 12 291 nurses from 23 general hospitals were selected by stratified cluster sampling. The nurses were investigated with the Turnover Intention Questionnaire, Work-Family Conflict Scale and Perceived Person-Environment Fit Scale. Pearson correlation analysis was used to explore the correlation between nurses' work-family conflict, person-environment fit and turnover intention. Multiple linear regression analysis was used to explore the influencing factors of nurses' turnover intention among different generations. A total of 12 291 questionnaires were distributed and 12 291 were retrieved. After eliminating the questionnaires with obvious logical errors, 11 753 valid questionnaires were finally recovered, with an effective recovery rate of 95.62% (11 753/12 291) .Results:The turnover intention of post-70s nurses was lower than that of post-80s and post-90s nurses. Work-family conflict, person-environment fit and whether the nurses have experienced negative events in the past year were the common influencing factors of nurses' turnover intention among different generations ( P<0.01) . The professional title, the number of night shifts and the fertility were the specific influencing factors of the post-90s nurses' turnover intention ( P<0.05) . The employment form was the specific influencing factor of post-80s nurses' turnover intention ( P<0.05) . Conclusions:The turnover intention of post-80s and post-90s nurses were higher than that of the post-70s nurses. There are differences in the current situation and influencing factors of nurses' turnover intention in different birth years. It is suggested that intervention strategies should be formulated according to the intergenerational characteristics of nurses to effectively reduce nurses' turnover intention.

Objective To construct a rational and efficient bed resource allocation management model to reduce pre-hos-pital waiting times,ensure patient safety,and improve satisfaction.Methods Based on lean management principles,a bed re-source allocation management model was developed and continuously optimized.The study compared bed turnover rates and effi-ciency indices,as well as preoperative waiting times for surgical patients,average length of stay,patient satisfaction,and anxiety incidence before and after the implementation of the lean model to evaluate its effectiveness.Results After implementing the lean bed resource allocation model,the bed efficiency index increased by 14.29％,and bed turnover rates improved by 3.34％.The average preoperative waiting time for surgical patients decreased by 100％,and the average length of stay reduced by 87.71％.Patient satisfaction increased by 2.4％,while anxiety incidence dropped by 28.1％.Conclusion The implementa-tion of a lean bed resource allocation model can enhance hospital bed efficiency,shorten preoperative waiting times for surgical patients,reduce average length of stay,and improve patient satisfaction.

Background Lipid metabolism imbalance is tightly linked to the development and progression of multiple diseases. The phosphatidylinositol 3-kinase/protein kinase B/mammalian target of rapamycin (PI3K/AKT/mTOR) signaling pathway is important for the regulation of lipid metabolism. However, whether silicosis is associated with lipid metabolic abnormalities has yet to be explored. Objective To observe the changes of lipid deposition, cholesterol, and phosphorylated proteins of PI3K/AKT/mTOR pathway in silicon dioxide (SiO₂)-induced MLE-12 cells and to explore potential mechanism of lipid composition regulated though the pathway. Methods (1) MLE-12 cells were stimulated with 50 mg·L⁻¹ SiO₂ suspension, and divided into fourgroups: a control group and three SiO₂ groups (12, 24, and 48 h of stimulation). (2) Cellproliferation was detected to determine an optimal dose of LY294002, an inhibitor of PI3K protein. LY294002 at 5 μmol·L⁻¹ was used for further study, in which MLE-12 cells cultured for 48 h were divided into four groups: a control group; a 50 mg·L⁻¹ SiO₂ suspension stimulation group; a 50 mg·L⁻¹ SiO₂ suspension and 5 μmol·L⁻¹ LY294002 treatment group; a 5 μmol·L⁻¹ LY294002 treatment group. Total cholesterol (TC), free cholesterol (FC), cholesterol ester (CE; total cholesterol minus free cholesterol), and triglycerides (TG) were measured with enzyme assay kits. Lipid deposition was observed using Oil Red O staining. The expressions of p-PI3K, p-AKT, and p-mTOR proteins were detected by Western blotting. Results (1) The contents of TC, FC, and CE in the 50 mg·L⁻¹ SiO₂-induced MLE-12 cells were increased compared to those of the control group in a time-dependent manner by trend analysis, and the increment at 24 and 48 h were significant. By 48 h, the contents of cholesterol indicators were all elevated: TC from (2.242±0.181) mg·g⁻¹ to (5.148±0.544) mg·g⁻¹, FC from (1.923±0.158) mg·g⁻¹ to (4.168±0.433) mg·g⁻¹, and CE from (0.318±0.067) mg·g⁻¹ to (0.978±0.134) mg·g⁻¹, compared with the control group (P<0.01). The changes of TG were not significant (P>0.05). The SiO₂ suspension induced orange-red particle deposition in the MLE-12 cells, especially at 48 h (P<0.01). The protein expression levels of p-PI3K, p-AKT, and p-mTOR in SiO₂-stimulated MLE-12 cells were higher than those of the control groups with the prolongation of stimulation time, which peaked at 48 h (P<0.01). (2) The contents of TC, FC, and CE in MLE-12 cells of the SiO₂ + LY294002 group were decreased, comparing to those of the SiO₂ stimulation only group (P<0.01), companied with less orange-red lipid deposition, and suppressed protein expression levels of p-PI3K, p-AKT, and p-mTOR (P<0.01). Conclusion SiO₂ could induce increases of cholesterol and lipid deposition through activation of PI3K/AKT/mTOR signaling pathway in MLE-12 cells.