Clinical skills training center of Dongyang People's hospital introduced lean man-agement conception into the resident clinical skills training. The recruited residents were grouped by degree, the training contents were detailed, and teaching plans were normalized, and small class teach-ing and real-time feedback were implemented, which improved the normalization and standardization of resident training. The implementation of lean management leads to great progress in resident train-ing, but still needs further efforts. Only in the long-term management of standardization, can lean man-agement conception be embedded in daily work, making clinical skills training center play its role in cultivating medical talents effectively.

Objective: To analyze the trend in disease burden of stroke in Linping District, Hangzhou City from 2014 to 2023, so as to provide the basis for prevention and control of stroke. Methods: Data on incidence and mortality of stroke in Linping District from 2014 to 2023 were collected through the Chronic Disease and Death Cause Monitoring System of Hangzhou Center for Disease Control and Prevention. The disease burden was evaluated by calculating years of life lost (YLL), years lived with disability (YLD) and disability-adjusted life years (DALY) with reference to the methodology of the Global Burden of Disease Study, and standardized using the data of the seventh national population census in 2020. The trend was analyzed using average annual percent change (AAPC). The disease burden of stroke attributed to risk factors was calculated. Results: The crude incidence of stroke was 298.13/105 and the crude mortality was 62.72/105 in Linping District from 2014 to 2023. The YYL, YLD and DALY caused by stroke were 49 413.60, 8 197.68, and 57 611.28 person-years, respectively, with decreasing trends in YLL and DALY, and an increasing trend in YLD (AAPC=-12.663%, -10.427% and 3.035%, all P<0.05). The standardized YLL rate, standardized YLD rate and standardized DALY rate were 9.54‰, 1.53‰ and 11.07‰, respectively, showing decreasing trends (AAPC=-16.011%,-0.975% and -13.791%, all P<0.05). Higher standardized DALY rate (P<0.05) and slower decline were seen in men than in women (AAPC=-13.025% vs. -14.550%, both P<0.05). The highest DALY of stroke was attributed to combined risk factors (men, 18 754.05 person-years; women, 13 256.60 person-years), followed by hypertension (men, 12 231.23 person-years; women, 9 373.77 person-years). The DALY of stroke attributed to smoking was 15.67 times higher in men than in women, and the DALY of stroke attributed to a lack of exercise was 1.27 times higher in women than in men. Conclusion There was an overall decreasing trend in the disease burden of stroke in Lingping District from 2014 to 2023, with a higher disease burden in men. The coexistence of multiple risk factors had a greater impact on stroke.

A novel flow-injection chemiluminescence (FI-CL) method free of CL reagent was developed for the determination of captopril based on its enhancing effect on the CL derived from diperiodatoargentate(III)-sulfuric acid system. Compared with the conventional CL system, the CL system based on trivalent silver was characterized of good selectivity for the absence of CL reagent. The CL mechanism was discussed through CL spectra and UV–vis absorption spectra. The conditions of the FI-CL system were investigated and optimized. Under the optimal conditions, the relative CL intensity was linear with the captopril concentration in the range of 0.3–15.0 μg/mL. The detection limit for captopril was 0.05 μg/mL, and the relative standard deviation (n=11) was 2.0% for 5.0 μg/mL captopril. The proposed method was applied to the analysis of captopril in tablet and human urine with the recoveries of 83.1%–112.5%, and the relative standard deviations of 0.5%–4.4%. The results obtained by the proposed method agreed well with those obtained from HPLC method. The proposed method is fast, convenient, and cost-effective for the determination of captopril in medicine and biological samples.

OBJECTIVE To observe prenatal nicotine exposure (PNE) induced high sensitivity of hypo?thalamic-pituitary-adrenal (HPA) axis in offspring rats which were fed with a high-fat diet, and to explore the mechanism. METHODS Nicotine (2 mg·kg-1 per day) was injected subcutaneously to preg?nant Wistar rats from gestational day (GD) 9 to GD20,and then the young rats were naturally delivered. After weaning, half of the offspring was fed with a high-fat diet until postnatal weeks (PW) 20. The others were exposed to unpredictable chronic stress (UCS) from PW17 to PW20. The pathological changes in the hippocampus were analyzed by HE staining. The blood concentration of adrenocorticotropic hormone (ACTH) and corticosterone (CORT) was detected by RIA kits and ELISA kits, respectively. Meanwhile, real-time PCR was used to detect the mRNA expression of ACTH releasing hormone (CRH), arginine vasopressin (AVP), vesicular glutamate transporter 2 (VGluT2), glutamic acid decarboxylase 65 (GAD65), mineralocorticoid receptor (MR),glucocorticoid receptor (GR) and glutamic acid decarboxylase 67 (GAD67). RESULTS In the normal control group,UCS treatment increased the level of serum ACTH and CORT 1.96 and 3.24 times in female rats,but 1.63 and 3.54 times in male rats. In the PNE group, UCS treatment increased the level of serum ACTH and CORT 3.96 and 5.98 times in female rats, but 3.04 and 5.22 times male rats. PNE increased the mRNA expression of AVP in the female and male rats 2.04 and 1.13 times in UCS treatment control group, and the mRNA expression of hypothalamus CRH and the ratio of VGLuT2/ GAD65 were increased 2.49 and 1.14 times in female rats, respectively. Furthermore, the nicotine group exhibited histological changes to different degrees in the hippocampus and dentate gyrus area of the hippocampus. In the female and male nicotine groups, the mRNA ratio of hippocampal MR/GR decreased by 88.0% and 86.0% in comparison with the normal control group without UCS, and the mRNA expression of GAD67 was enhanced 1.38 and 1.97 times in female and male rats without UCS. In the female UCS treatment nicotine groups, the mRNA expression of GAD67 was increased 2.17 times compared with the UCS treatment control group. CONCLUSION PNE can induce a high sensibility of HPA axis in offspring rats fed with a high-fat diet. The imbalance of hippo?campus MR/GR and the enhanced expression of GAD67 mRNA may be involved.

Objective:To observe the effects of different moxibustion times on proteins of transient receptor potential vanilloid 3 (TRPV3) ion channel protein and synovial cell apoptosis in rats with rheumatoid arthritis (RA), to provide a new basis for the anti-inflammatory mechanism of moxibustion. Methods:A total of 50 Sprague-Dawley (SD) rats were divided into a normal group, a model group, moxibustion groupⅠ, moxibustion groupⅡ and moxibustion groupⅢ by complete randomization, with 10 rats in each group. Rats in the normal group were bred routinely, and rats in the model group were also bred routinely after successful modeling. After successful modeling, rats in moxibustion groupⅠ,Ⅱ andⅢ accepted consecutive moxibustion at Zusanli (ST 36) and Shenshu (BL 23) for 15 d, once a day, respectively 5 min, 20 min and 30 min for each session. The degree of paw edema was observed and recorded. Immunohistochemical assay was used to detect the protein expression of TRPV3 ion channel in dorsal root ganglia and spinal cord dorsal horn. Terminal-deoxynucleoitidyl transferase-mediated nick end labeling (TUNEL) was used to detect apoptotic synovial cell number. Results: At the end of treatment, paw circumference of rats in moxibustion groupⅡ andⅢ were significantly reduced as compared with that in the model group (P<0.05). TRPV3 ion channel protein expression of dorsal root ganglia and spinal cord dorsal horn was higher in the model group than that in the normal group (P<0.05); the TRPV3 ion channel protein expressions of dorsal root ganglia and spinal cord dorsal horn in moxibustion groupⅡ andⅢ were higher than that in moxibustion groupⅠ (P<0.05); apoptotic synovial cell number in the model group was larger than that in the normal group (P<0.05), and apoptotic synovial cell numbers in moxibustion groupⅡ andⅢ were significantly higher than that in the model group (P<0.05). Conclusion:Moxibustion of appropriate time could induce TRPV3 expression, and promote synovial cell apoptosis.

Objective:Through the analysis of intelligent nursing patents, to provide reference for clinical nurses to understand the development trend of intelligent nursing patents and carry out related inventions.Methods:The website of China Intellectual Property Office and CNKI were searched with the keywords of " intelligence" , " intellectualization" and " artificial intelligence" , " nursing" and " nurse" from the establishment of the database to December 31, 2020. Information of the patent application time, application area, patent type, main classification number and other patent information were analyzed.Results:Until 2020, China applied for 4 128 patents related to intelligent nursing, among which invention patents were the most, and appearance patents were the least; before 2006, intelligent nursing patents were in the early stage of development, from 2006 to 2014, it showed a slow increasing trend, since 2015, it entered the stage of rapid growth; the regions with the largest number of applications were Shandong, Jiangsu, Guangdong, Shanghai and Zhejiang; IPC of A61, G06, H04, G16 and A47 accounted for the largest proportion, and showing an upward trend as a whole, but different technical fields show different growth rates; intelligent nursing was the most popular. The number of applications for beds and related ancillary products was the largest, followed by intelligent nursing monitoring equipment.Conclusions:It is suggested that to improve the patent incentive mechanisms, encourage nurses to solve clinical problems from an intelligent perspective, and actively promote the transformation of intelligent nursing patents.