Objective To explore the role of ATM/hnRNPK signaling in the adriamycin resistance of acute myeloid leukemia.Methods Expression of ATM was examined in the adriamycin resistant and sensitive leukemia cell strains with Western blot.ATM expression was down-regulated by RNAi and ATM inhibitor in the adriamycin resist-ant cell strains.Expression level of hnRNPK and LC3Ⅰ/Ⅱ was detected by Western blot and adriamycin sensitivity was measured by CCK8 assay before and after modulation of ATM expression.Results ATM was overex-pressed in adriamycin resistant leukemia cell strains.The decreased expression of ATM restored the sensitivity to adriamycin.Expression level of LC3Ⅱ and hnRNPK was consistent with the modulation of ATM expression.Conclusions The ATM/hnRNPK signaling pathway may play a role in the occurrence of adriamycin resistance in acute myeloid leukemia by regulating autophagy.

Objective:To construct a postoperative nursing plan for liver transplant recipients using the NANDA international, nursing outcomes classification, nursing intervention classification (NANDA-I-NOC-NIC) link (referred to as NNN-link) as the theoretical framework, so as to optimize the nursing process after liver transplantation and improve the quality of nursing.Methods:This study retrospectively collected nursing diagnoses with a postoperative usage rate of over 50% from 300 liver transplant recipients at Shulan (Hangzhou) Hospital from January 2019 to December 2021, and matched nursing outcomes and measures based on the NNN-link theory framework. After two rounds of Delphi expert consultation and group discussion, the entry content was rated, discussed, and modified to form the final version of the postoperative NNN-link for liver transplant recipients.Results:In two rounds of expert consultation, the recovery rates were 96.67% (29/30) and 100.00% (29/29) , respectively. The expert authority coefficients were 0.83 and 0.84, respectively. The Kendall harmony coefficients for the second round were 0.50, 0.38, 0.35. The final postoperative NNN-link for liver transplant recipients included 15 nursing diagnoses, 42 nursing outcomes, and 106 nursing measures.Conclusions:The process of constructing the postoperative NNN-link for liver transplant recipients is scientific and reasonable, and the entries are highly specialized, which can provide reference for clinical nursing after liver transplantation.

Objective To comprehensively evaluate the current clinical application status of evidence regarding immunosuppressive medication compliance management in kidney transplant patients,construct review indicators,analyze the obstacles and promoting factors,and further formulate reform strategies.Methods Using the Joanna Briggs Institute evidence-based health care model as the theoretical framework,clinical nursing issues were identified,and a systematic search,evaluation,and summarization of 38 items of evidence were conducted.An evidence-based practice group was established;review indicators were constructed;review methods were clarified.Baseline reviews of systems,healthcare professionals,patients,and their families were conducted from November 1,2022,to January 31,2023.According to the review results,the obstacles and promoting factors in the process of evidence-based practice were analyzed,and corresponding strategies were formulated.Results A total of 23 review indicators were constructed.Among them,the accurate execution rate of 15 indicators was less than 60％,and the accurate execution rate of 4 indicators was 0.The main obstacles include a lack of systems and processes in departments,poor knowledge,attitude,and practice of medical staff,a lack of standardized risk assessment,and a lack of information support for out-of-hospital management.The primary promoting factors are strong organizational leadership,multidisciplinary team support,and high participation enthusiasm of recipients and their families.Corresponding reform strategies are formulated accordingly,including process and system improvement,continuous quality monitoring,enhanced standardized training and assessment,electronic health intervention for medication compliance,and involving patients and their families in the medication compliance management process.Conclusion There is a significant gap between the evidence on immunosuppressive medication compliance management in kidney transplant patients and its clinical practice.It is essential to assess the obstacles and facilitators scientifically and comprehensively in clinical situations,employ targeted reform strategies,facilitate the translation of evidence into clinical practice,and enhance the quality of nursing care.

Objective To analyze the application of a nursing outcome classification system in postoperative nursing of liver transplantation patients and its influence on the quality of clinical nursing records.Methods A total of 44 patients who underwent liver transplantation in a tertiary A general hospital in Zhejiang Province from March to August 2023 were selected by convenience sampling method.According to the North American Nursing Diagnosis Association International-Nursing Outcomes Classification linked scale of liver transplantation,nurses used the five-level classification method to score and review the liver transplantation patients on the day after surgery,3d after surgery,7d after surgery,14d after surgery,and on the day of discharge.The nursing outcome classification scores at 5 time points were statistically analyzed.The nursing records of 44 patients with liver transplantation from June to December 2022 were retrospectively collected by convenient sampling,and 44 nursing records before Nursing Outcomes Classification application and 44 nursing records after Nursing Outcomes Classification implementation were measured by Quality of Documentation of Nursing Diagnoses,Interventions and Outcomes.Results The Nursing Outcomes Classification scores of 15 nursing diagnoses were analyzed by single factor repeated measurement,and 9 of them showed continuous improvement and significant difference at 4 measurement time points(P＜0.05).After Nursing Outcomes Classification implementation,the total score of nursing record quality,nursing diagnosis and nursing outcome record quality scores were higher than those before implementation,with statistically significant differences(P＜0.05).Conclusion The nursing outcome classification system can be used to evaluate the postoperative health status and nursing effect of adult liver transplantation patients.It has high specialty specificity and can improve the quality of nursing records.

L-theanine has been shown to have a therapeutic effect on depression.However,whether L-theanine has an excellent preventive effect on depression in children and adolescents and what its mechanism is have not been well explained.Given the complexity of the pathogenesis of depression,this study investigated the preventive effect and mechanism of L-theanine on depression in juvenile rats by combining serum and hippocampal metabolomic strategies.Behavioral tests,hippocampal tissue sections,and serum and hippocampal biochemical indexes were studied,and the results confirmed the preventive effect of L-theanine.Untargeted reversed-phase liquid chromatography-quadrupole-time-of-flight mass spec-trometry and targeted hydrophilic interaction liquid chromatography-triple quadrupole mass spec-trometry were developed to analyze the metabolism changes in the serum and hippocampus to screen for potential biomarkers related to L-theanine treatment.The results suggested that 28 abnormal me-tabolites in the serum and hippocampus that were considered as potential biomarkers returned to near-normal levels after L-theanine administration.These biomarkers were involved in various metabolic pathways,mainly including amino acid metabolism and lipid metabolism.The levels of amino acids and neurotransmitters in the phenylalanine,tryptophan,and glutamic acid pathways were significantly reduced after L-theanine administration compared with chronic unpredictable mild stress-induced rats.In summary,L-theanine had a significant preventive effect on depression and achieved its preventive results on depression by regulating various aspects of the body,such as amino acids,lipids,and inflammation.This research systematically analyzed the mechanism of L-theanine in preventing depression and laid the foundation for applying L-theanine to prevent depression in children and adolescents.

Objective:To investigate the current status and evolutionary trajectory of research on the information management of pressure injury care in hospitals of China.Methods:The bibliometric method was used for analysis. Using the China National Knowledge Infrastructure (CNKI) database as the data source, the literature on information management of pressure injury care in hospitals was retrieved, covering the time period from the establishment of the CNKI database to July 31, 2022, and various types of literature such as guidelines, expert consensus, case studies, reviews, and survey reports, etc. Visualized analysis of clustering and co-occurrence on the keywords, authors, publishing institutions, and number of journals of the included literature were performed using CiteSpace 6.1.R2 software.Results:A total of 378 articles were retrieved, and 323 articles were included after collation. The number of literatures related to nursing information management of pressure injury in hospitals showed a significantly upward trend since 2012. Ten core authors published two or more articles as the first author. There were eight groups of co-authors with ≥3 people. Furthermore, 306 institutions contributed articles related to the information management of pressure injury care, with Peking University Shenzhen Hospital as the institution publishing the most articles (4 articles). Cooperation between institutions was relatively decentralized. The 323 included literature were sourced from 142 journals, six of which had published ten or more articles. A comprehensive co-occurrence analysis of 282 Chinese keywords was performed, with the top three keywords in terms of frequency being pressure ulcer, nursing management, and nursing. A total of 13 clusters were formed, and the persistent clusters were #1 quality of care, #2 nursing, and #6 surgical patients. The top 8 emergent keywords of emergence intensity in the database included early warning intervention, early warning management, early warning mechanism, information system, nursing safety, adverse events, operating room, and quality of care. In the past three years (2020-2022), the top two emergent keywords in terms of emergy intensity included operating room and quality of care. The key word with the longest duration (2005-2012) and the highest intensity was early warning intervention.Conclusions:The research hotspots on information management of pressure injury care in domestic hospitals have been formed. Early studies focus on the intervention after the pressure injury developed, while later studies focus more on the overall management of pressure injuries. Collaboration between institutions within research areas and correlations between studies are still lacking.

Objective:To observe the clinical characteristics and guideline compliance of chronic obstructive pulmonary disease (COPD) patients with initial triple therapy in real-life world.Methods:This study is a cross-sectional study. The subjects of the study were COPD patients admitted to 13 hospitals in Hunan Province and Guangxi Zhuang Autonomous Region from December 2016 to December 2021. The initial treatment was triple inhaled drugs. The data collected included gender, age, diagnosis, body mass index (BMI), history of acute exacerbation (AE) in the past year, pulmonary function, COPD Assessment Test (CAT) score, modified British Medical Research Council Dyspnea Questionnaire (mMRC), inhaled drugs and other indicators. The characteristics and differences of COPD patients before and after 2020 were analyzed.Results:7 184 patients with COPD were enrolled in this study, including 2 409 COPD patients treated with initial triple therapy, accounting for 33.5%(2 409/7 184). Taking January 1st, 2020 as the cut-off point, 1 825 COPD patients (75.8%) received initial treatment with triple inhaled drugs before 2020 and 584 patients (24.2%) after 2020 were included in this study. Compared with COPD patients before 2020, the COPD patients after 2020 had higher FEV 1% [(40.9±15.5 )% vs (39.3±15.5)%, P=0.040], lower CAT [(15.8±6.5)point vs (17.5±6.2)point, P<0.001], less AE in the past year [1(0, 2)times vs 1(0, 2)times, P=0.001] and higher rate of non-AE [255(43.7%) vs 581(37.1%), P=0.006]. In addition, before 2020, patients with COPD were mainly treated with open triple drugs (1 825/1 825, 100%); after 2020, 306 patients (52.4%) received open triple inhaled drugs, and 278 patients (47.6%) received closed triple inhaled drugs. Conclusions:In real-life world, most of patients with COPD treated with triple therapy have severe lung function, obvious symptoms and high risk of acute exacerbation. The real-world prescribing of triple therapy in patients with COPD does not always reflect recommendations in guidelines and strategies, and overtreatment is common. After 2020, prescribing triple therapy for COPD patients is more positive and worse consistency with guideline.

This study takes the online teaching of oncological radiotherapy for standardized residency training in Harbin Medical University Cancer Hospital as an example, interprets the practice of carrying out online education, thinks about the problems in the teaching process, and is committed to making great contributions to the improvement of medical education quality in the new era and new background.

In the COVID-19 epidemic prevention and control work, not only the safety management of in-hospital organ transplantation is facing severe challenges, but also a large number of patients at home after transplantation are in immunosuppressive state, and professional protection management is urgently needed. Since the outbreak of the epidemic, Shulan(Hangzhou)hospital fully identified the risks of transplant patients, established a special team, and formulated and implemented the control management plan for organ transplant patients based on the crisis leadership model. The control management plan has achieved staged results.From January 15 to March 2, 2020, 29 liver transplants and 31 kidney transplants were performed in our hospital. The remote health education of 1 002 patients after liver and kidney transplantation was completed. The goal of " zero infection" was achieved, and the protection management quality indicators were ideal.

Objective:To explore the effects of teamwork strategy in cardiac rehabilitation exercise therapy for elderly patients with myocardial infarction.Methods:From November 2017 to May 2019, we selected elderly patients with myocardial infarction at Shulan (Hangzhou) Hospital as the study objects by convenience sampling. All patients were divided into control group ( n=58) and observation group ( n=60) . Control group implemented the routine nursing. On the basis of routine nursing, observation group carried out the cardiac rehabilitation exercise therapy by applying the teamwork strategy. We compared the exercise compliance and activities of daily living (ADL) of patients between two groups. Results:The exercise compliance of patients in observation group was higher than that in control group with a statistical difference ( P<0.01) . At discharge, the score of Barthel index of patients in observation group was higher than that in control group also with a statistical difference ( P<0.01) . Conclusions:Teamwork strategy helps to improve the exercise compliance and ADL in elderly patients with myocardial infarction.