Esophageal pressure(Pes)is usually measured via a catheter with an air - filled thin - walled latex balloon inserted nasally or orally. To validate Pes measurement,a dynamic occlusion test measures the ratio of change in Pes to change in Paw during inspiratory efforts against a closed airway. This report summarizes current physiological and technical knowledge on esophageal pressure measurements in patients receiving mechanical ventilation. The respiratory changes in Pes are representative of changes in pleural pressure. The difference between airway pressure(Paw)and Pes is a valid estimate of transpulmonary pressure. Because of the nonuniformity of lesion of pulmonary in patient with acute respiratory distress syndrome,Paw and volume can not represent the stress to expand the pulmonary. How to adjust posi-tive end expiratory pressure(PEEP)is still lack of gold standard. The use of Pes for PEEP titration may help improve oxygenation and compliance,or even has the possibility to improve the patient outcome.

Objective To study the effect of rosuvastatin calcium combined with clopidogrel and aspirin on preventing cerebral infarction in elderly patients with transient ischemic attack, and the influence on blood lipid and platelet.Methods 80 elderly patients with TIA were treated in Haiyan people's hospital from September 2014 to May 2017.All the patients were randomly divided into the observation group and the control group with 40 cases in each group.The control group were treated with clopidogrel and aspirin, and the observation group was treated with rosuvastatin calcium combined with clopidogrel and aspirin.The effect of cerebral infarction prevention, blood lipid and platelet change were compared between the two groups.Results Cerebral infarction incidence was 5% in the observation group, the incidence of adverse reactions was 10%, which were significantly lower than 22.5% and 17.5% in the control group, the differences were statistically significant (P<0.05).Compared two groups of patients with blood lipid levels after the treatment, the indicators of the observation groupTC (4.89±1.13) mmol/L、TG (1.04±1.02) mmol/L、LDL-C (2.62±1.22) mmol/L was significantly lower than the control group (5.57±1.20) mmol/L、(1.58±1.06) mmol/L、(3.39±1.24) mmol/L, with statistical significance (P<0.05).After treatment, PT (16.88±1.97), APTT (46.23±4.22) in the observation group were longer than (14.01±2.02) (38.21±3.99) in the control group, PLT (150.44±9.87) in the observation group is lower (165.82±9.71) in the control group, the differences were statistically significant (P<0.05).Conclusion Rosuvastatin calcium combined with clopidogrel and aspirin has a significant effect on the prevention of elderly patients with transient ischemic attack of cerebral infarction, which can reduce the blood lipid level, prolong PT, reduce PLT, APTT, and has high value in clinical application.

Objective:To construct a training course system for online appointment nurses based on post competence,and to provide references for the training and development of online appointment nurses in China.Methods:From January 2021 to May 2022, based on the theory of post competence, literature review, policy research, questionnaire survey and and expert consultation were used to establish the training course system of online appointment nurses.Results:The effective recovery rates of the two rounds of expert consultation questionnaires were 18/18 and 17/18, respectively; the expert authority coefficient was 0.928 and 0.938, respectively; and the Kendall harmony coefficient was 0.185 and 0.284, respectively, the differences were statistically significant (all P<0.001). The final content of the training course system for online appointment nurses included 4 first-level indicators,which were professional knowledge, professional skills, professional abilities and traits, 19 second-level indicators and 58 third-level indicators. Conclusions:The training course system of online appointment nurses based on post competency is scientific, reasonable and prominent,which can provide reference for training of online appointment nurses in China.

Objective:To survey the job satisfaction of online contracted nurses who provide " Internet plus nursing services" for reference of hospital managers in improving their management mechanism in this regard.Methods:Based on the two-factor theory, a questionnaire was designed and a purposive sampling method was used to survey the online contracted nurses in Anhui province in April and May 2022. The motivational factors included such five dimensions as workload, work content, colleague relationship, doctor-patient relationship, and their own development, and the healthcare factors included such three dimensions as salary, job recognition and social status. The questionnaire data and job satisfaction scores were analyzed descriptively, and the correlation between the overall job satisfaction of the online contracted nurses, while each dimension was analyzed by Pearson correlation analysis, and the influence of each dimension on job satisfaction was analyzed by stepwise regression analysis.Results:A total of 335 valid questionnaires were recovered. The mean score of job satisfaction of online contracted nurses was (2.26±0.38), with the highest score of (2.56±0.53) for salary satisfaction and the lowest score of (1.78±0.67) for job recognition, and each dimension was positively correlated with job satisfaction ( r=0.34-0.88, P<0.01). Regression analysis showed that workload ( B=0.07), salary ( B=0.11), job content ( B=0.23), social status ( B=0.12), and self-development ( B=0.15) were the main factors affecting their job satisfaction ( P<0.01). Conclusions:The job satisfaction of online contracted nurses was at a medium level, mainly influenced by workload, salary, job content, social status and their own development. It is recommended that hospitals implement multiple targeted measures to improve the job satisfaction of online contracted nurses and promote the healthy development of " Internet plus nursing services" .

【Objective】 To investigate the effects of the loss of exon 1 of TFE3 on nuclear localization of chimeric TFE3 protein in TFE3 translocation renal cell carcinoma (TFE3 tRCC). 【Methods】 The localization of TFE3 protein in TFE3 tRCC and clear cell renal cell carcinoma (ccRCC) were detected with immunochemistry. The exon retention of TFE3 gene in TFE3 tRCC was analyzed in databases and literatures. The plasmids containing TFE3 full-length and different-length of TFE3 exons which were constructed to pCDH-MCS-EGFP-Puro were transfected into HEK293T using Lipo Fiter^TM. The localization of EGFP protein in HEK293T cells were detected with confocal microscopy. The localization of TFE3 protein and truncated TFE3 protein were detected with Western blotting. The mRNA expression of the downstream genes of TFE3 protein were detected with q-PCR. 【Results】 Strong nuclear signal of TFE3 protein was observed in TFE3 tRCC, whereas TFE3 protein in ccRCC was mainly localized in cytoplasm. The results of fluorescence imaging and Western blotting showed that TFE3 full-length protein was expressed both in nucleus and cytoplasm, and the expression of truncated TFE3 protein was mainly localized in nucleus. The q-PCR analysis demonstrated that the deletion of exon 1 in TFE3 gene led to a higher transcriptional level of targeted genes of TFE3 protein. 【Conclusion】 The loss of exon 1 in TFE3 played a critical role in preventing TFE3 protein from entering the nucleus. In TFE3 tRCC, the loss of exon 1 in TFE3 gene leads to the nuclear localization of TFE3 fusion protein and activation of its downstream target genes. This mechanism promises to uncover the occurrence and development of TFE3 tRCC.