Objective:To construct a core competency indicator system for prehospital emergency nursing staff in stroke.Methods:A preliminary draft of the core competency indicator system for prehospital emergency nursing staff in stroke was formulated through literature research and group discussions. From January to March 2023, 15 experts were selected, and after two rounds of Delphi expert consultations, the indicators at all levels were modified and improved to form the final version of the indicator system. The degree of expert enthusiasm was expressed as the effective response rate of the questionnaire, the degree of expert authority was expressed as the expert authority coefficient ( Cr), and the degree of expert opinion coordination was expressed as the Kendall harmony coefficient and coefficient of variation. Results:In two rounds of Delphi expert consultation, the effective response rates of the questionnaire were 100.00% and 93.33%, respectively, and the expert authority coefficients were 0.853 and 0.861. After the second round of expert consultation, the coefficient of variation for each item was from 0 to 0.23, and the Kendall's harmony coefficient was 0.185 ( P<0.01). The final constructed indicator system included four primary indicators, 14 secondary items, and 31 tertiary items. Conclusions:The constructed core competency indicator system for prehospital emergency nursing staff in stroke is scientific and reliable, and can provide reference for the training and assessment of prehospital emergency nursing staff.

Objective:To retrospectively analyze the clinical efficacy and safety of rivaroxaban alone or in combination with folic acid/methylprednisolone in the treatment of livedoid vasculopathy (LV) .Methods:Clinical data were retrospectively collected from LV patients who were treated with rivaroxaban alone or in combination at the Department of Dermatology, Kaifeng People's Hospital from April 2020 to September 2023. Before treatment, all the patients underwent serum folate and homocysteine tests. Folic acid therapy was given to patients with low folate levels; glucocorticoid therapy was given to patients with generalized skin lesions in the extremities in the acute stage or with dense inflammatory cell infiltration around the dermal vessels on histopathological examination. Clinical symptoms (erythema, ulceration and pain) were scored before and after 8 weeks of treatment. Adverse reactions were recorded during the treatment.Results:A total of 11 patients were collected, including 6 males and 5 females; their ages ranged from 15 to 73 (29.00 ± 17.85) years, and the disease duration ranged from 1 month to 4 years (13.36 ± 15.87 months). Among the 11 patients, 3 were treated with rivaroxaban combined with methylprednisolone and folate, 1 with rivaroxaban combined with methylprednisolone, 5 with rivaroxaban combined with folate, and 2 with rivaroxaban alone. The total score of clinical symptoms was 5.00 ± 2.28 points before treatment, and significantly decreased to 1.18 ± 0.75 points after 8 weeks of treatment with rivaroxaban alone or in combination ( t = 6.90, P = 0.001). In addition, the pain scores of 5 patients who reported pain dropped to 0 point after 8 weeks of treatment. One patient experienced coagulation abnormalities after 2 weeks of treatment, and the coagulation parameters returned to normal without special treatment after 4 weeks. Conclusion:Rivaroxaban alone or in combination with folic acid/methylprednisolone was effective for the treatment of LV with a good safety profile.

Objective:To investigate the efficacy and adverse reactions of simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) combined with chemotherapy in the treatment of superior mediastinal lymph node metastasis after esophageal cancer surgery.Methods:The clinical data of 72 patients with concurrent chemoradiotherapy for superior mediastinal lymph node metastasis after esophageal cancer surgery in Tai'an Cancer Prevention and Treatment Hospital from January 2019 to May 2021 were retrospectively analyzed, and they were divided into intensity-modulated radiotherapy (IMRT) group (36 cases) and SIB-IMRT group (36 cases) according to different radiotherapy methods. The short-term efficacy, long-term survival rate and adverse reactions of the two groups were compared.Results:The response rate in the IMRT group was 66.7% (24/36), the response rate in the SIB-IMRT group was 86.1% (31/36), and the difference between the two groups was statistically significant ( χ2 = 3.77, P = 0.047). The 1-, 2- and 3-year overall survival rates in the IMRT group were 75.0%, 44.4% and 27.8%, and the 1-, 2- and 3-year overall survival rates in the SIB-IMRT group were 83.3%, 52.8% and 33.3%; the difference in the overall survival between the two groups was not statistically significant ( χ2 = 0.70, P = 0.401). There were statistical differences in the incidence of leukopenia, radiation esophagitis and radiation pleural gastritis between the two groups (all P < 0.05). There were no statistical differences in the incidence of radiation pneumonia and gastrointestinal reactions between the two groups (both P > 0.05). Conclusions:SIB-IMRT combined with chemotherapy in patients with superior mediastinal lymph node metastasis after esophageal cancer surgery has good local control rate and mild adverse reactions.

Objective To investigate the application value of tenofovir alafenamide fumarate (TAF) in elderly patients with chronic hepatitis B (CHB) and its influence on bones and kidneys. Methods A total of 36 CHB patients, aged ≥60 years, who received TAF antiviral therapy in Qingdao Municipal Hospital, The Affiliated Hospital of Qingdao University, Qingdao Sixth People's Hospital, Chengyang People's Hospital, and Jimo People's Hospital from June 2021 to October 2022 were enrolled in this study, and all patients received TAF (25 mg/d) antiviral therapy. Related data were collected at baseline and weeks 24 and 48 of treatment, including virological indicators, biochemical parameters, urinary protein electrophoresis indices, transient elastography (FibroScan), and bone mineral density. Virological indicators included high-sensitivity HBV DNA quantification; biochemical parameters included total bilirubin, direct bilirubin (DBil), indirect bilirubin (IBil), alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, gamma-glutamyl transpeptidase, total bile acid (TBA), glucose, blood urea nitrogen, creatinine, estimated glomerular filtration rate, and cystatin C (Cys C); urinary protein electrophoresis indices included urinary β2 microglobulin (β2-MG), urinary retinol (URBP), and urinary α1 microspherin (α1-MG). The paired t -test was used for comparison of normally distributed continuous data before and after treatment, and the Wilcoxon signed-rank test was used for comparison of non-normally distributed continuous data before and after treatment; the chi-square test or the Fisher's exact test was used for comparison of categorical data. Results A total of 36 CHB patients completed 24 weeks of follow-up. The complete virological response rate after 24 weeks of treatment was higher than that at baseline [83.3% (30/36) vs 77.8% (28/36), χ 2 =0.36, P =0.55], and there were significant reductions in DBil ( t =-2.42, P =0.02) and Cys C ( t =-4.34, P < 0.001) from baseline to week 24. A total of 18 CHB patients completed 48 weeks of follow-up. The complete virological response rate after 48 weeks of treatment was higher than that at baseline (94.4% vs 77.8%, χ 2 =2.22, P =0.34), and there were significant increases in IBil ( t =2.43, P =0.03), TBA ( Z =-2.24, P =0.03), and bone mineral density T score of lumbar vertebra ( t =2.92, P = 0.01) and femoral neck ( t =2.42, P =0.03) and a significant reduction in liver stiffness measurement ( t =-2.31, P =0.03). There were no significant changes in β2-MG, URBP, and α1-MG after treatment (all P > 0.05). Conclusion TAF has a good antiviral effect in CHB patients aged ≥60 years and can help more CHB patients achieve complete virological response, without causing damage to the kidney, and it can also improve bone mineral density and liver fibrosis degree.

Objective:To explore the effect of nursing intervention based on nursing outcomes classification in patients with acute myocardial infarction after percutaneous coronary intervention (PCI) .Methods:From September to November 2021, a total of 86 patients with acute myocardial infarction after PCI admitted to Henan Provincial People's Hospital were selected as research subjects using convenience sampling method, and were divided into the observation group and the control group using the random number table method, with 43 patients in each group. The control group received routine nursing intervention, while the observation group received nursing intervention based on nursing outcomes classification. The incidence of complications, the scores of self-management ability, anxiety, depression, and quality of life were compared between the two groups.Results:After intervention, the incidence of complications of the observation group was lower than that of the control group, and the difference was statistically significant ( P<0.05). After intervention, the total score and dimension scores of self-management ability of the two groups were higher than those before intervention, and the scores of the observation group were higher those of the control group, with statistically significant differences ( P<0.05). After intervention, the scores of anxiety and depression of two groups were lower than those before intervention, and the scores of the observation group were lower than those of the control group, with statistically significant differences ( P<0.05). After intervention, the scores of physical function, physical pain, energy, emotional function, physical role, health status, and mental health scores of the observation group were higher than those of the control group, with statistically significant differences ( P<0.05) . Conclusions:Nursing intervention based on nursing outcomes classification can reduce the incidence of complications in patients with acute myocardial infarction after PCI, alleviate their anxiety and depression, improve their self-management ability and quality of life, which is worthy of clinical promotion and practice.

The responsibility of root is absorbing water and nutrients, it is an important plant tissue, but easily to be affected by biotic and abiotic stresses, affecting crop growth and yield. The design of a synthetic root-specific promoter provides candidate promoters for the functional analysis and efficient expression of stress-related genes in crop roots. In this study, a synthetic root-specific module (pro-SRS) was designed using tandem four-copies of root specific cis-acting elements (OSE1ROOTNODULE, OSE2ROOTNODULE, SP8BFIBSP8AIB, and ROOTMOTIFAPOX1), and fused with minimal promoter from the CaMV 35S promoter to synthesize an artificially synthetic SRSP promoter. The SRSP promoter was cloned in pCAMBIA2300.1 by replacing CaMV 35S promoter so as to drive GUS expression. The constructs with SRSP promoter were transformed in tobacco by Agrobacterium-mediated method. SRSP promoter conferred root-specific expression in transgenic tobacco plants through Real-time PCR (RT-PCR) analysis and GUS histochemical staining analysis. It is indicated that the repeated arrangement of cis-acting elements can realize the expected function of the promoter. This study laid a theoretical foundation for the rational design of tissue-specific promoters.
Agrobacterium ; genetics ; Cloning, Molecular ; Gene Expression Regulation, Plant ; Plant Roots ; genetics ; Plants, Genetically Modified ; Promoter Regions, Genetic ; genetics ; Stress, Physiological ; Tobacco ; genetics ; growth & development ; Transformation, Genetic

Objective:To explore the relationship between multiple health-risk behaviors and emotional and behavioral problems in preschool children.Method:From October to November 2017, 27 987 children aged 3 to 6 years from 109 kindergartens of 11 cities from Hubei, Anhui and Jiangsu Provinces in the middle and lower reaches of the Yangtze River were selected by using the cluster sampling method. Finally, 27 200 valid questionnaires were collected. A questionnaire was used to investigate the demographic characteristics, video time and outdoor activities, eating behavior, sleep time, emotional and behavioral problems of parents and children. Multivariate logistic regression model was used to quantify the association between multiple health-risk behaviors and emotional and behavioral problems.Results:Emotional symptoms, conduct problems, hyperactivity, peer problems, total difficulties and prosocial behavior abnormalities were detected in 9.5% (2 587), 9.5% (2 590), 18.2% (4 958), 24.5% (6 670), 11.2% (3 058) and 10.2% (2 770), respectively. Three groups of low, medium and high scores of multiple health-risk behaviors were accounted for 30.6% (8 316), 60.9% (16 568) and 8.5% (2 316), respectively. Multivariate logistic regression model analysis showed that after controlling for the confounding factors, compared with those in the low score group, preschool children in the middle and high score groups had higher risks of emotional symptoms, conduct problems, hyperactivity, peer problems, total difficulties and prosocial behavior (all Pvalues<0.05). Conclusion:Health-risk behaviors are associated with the emotional and behavioral problems of preschool children.

Objective:To explore the relationship between multiple health-risk behaviors and emotional and behavioral problems in preschool children.Method:From October to November 2017, 27 987 children aged 3 to 6 years from 109 kindergartens of 11 cities from Hubei, Anhui and Jiangsu Provinces in the middle and lower reaches of the Yangtze River were selected by using the cluster sampling method. Finally, 27 200 valid questionnaires were collected. A questionnaire was used to investigate the demographic characteristics, video time and outdoor activities, eating behavior, sleep time, emotional and behavioral problems of parents and children. Multivariate logistic regression model was used to quantify the association between multiple health-risk behaviors and emotional and behavioral problems.Results:Emotional symptoms, conduct problems, hyperactivity, peer problems, total difficulties and prosocial behavior abnormalities were detected in 9.5% (2 587), 9.5% (2 590), 18.2% (4 958), 24.5% (6 670), 11.2% (3 058) and 10.2% (2 770), respectively. Three groups of low, medium and high scores of multiple health-risk behaviors were accounted for 30.6% (8 316), 60.9% (16 568) and 8.5% (2 316), respectively. Multivariate logistic regression model analysis showed that after controlling for the confounding factors, compared with those in the low score group, preschool children in the middle and high score groups had higher risks of emotional symptoms, conduct problems, hyperactivity, peer problems, total difficulties and prosocial behavior (all Pvalues<0.05). Conclusion:Health-risk behaviors are associated with the emotional and behavioral problems of preschool children.

OBJECTIVE:To improve medication compliance of patients with nonvalvular atrial fibrillation (NVAF) to warfarin and its influential factors,and to provide reference for guaranteeing the safety and effectiveness of therapy.METHODS:A questionnaire survey was conducted among NVAF patients receiving warfarin anticoagulation in our hospital,MMAS-8 and WRKS were adopted to evaluate medication compliance of patients to warfarin and the understanding of patients to the knowledge of anticoagulation treatment.Related influential factors for medication compliance of patients to warfarin were investigated by x2 test,t test and Logistic multiple regression analysis.RESULTS:Totally 129 questionnaires were sent out,and 112 were effectively received with effective recovery of 86.82％.The mean score of MMAS was (6.54 ± 1.61),and 42.86％ patients had good medication compliance.The mean score of WRKS was (7.95 ± 1.65);that of patients with good medication compliance was (9.31 ± 0.83),and that of patients with poor medication compliance was (6.92 ± 1.34).Single factor analysis showed that there was statistical significance in gender,age,occupation,educational level,the number of compliance,WRKS score between patients with good medication compliance and those with poor medication compliance (P＜0.05).Multivariate Logistic regression analysis showed that WRKS score,gender,educational level and the number of compliance were significantly correlated with medication compliance (P＜0.05).CONCLUSIONS:Poor medication compliance of NVAF patients to warfarin is related to multiple influential factors.The knowledge of warfarin anticoagulation is an important factor.

Objective To evaluate the accuracy of human brucellosis diagnosis and reporting in medical institutions in Shanxi province, and understand the performance of clinical doctors to diagnose human brucellosis according to diagnostic criteria. Methods Field investigation was conducted in 6 medical institutions in the key areas of human brucellosis in Shanxi province. The diagnosis data of the reported brucellosis cases in 2015 were collected and reviewed retrospectively for the evaluation of the diagnosis accuracy with systematic sampling method. The database was established with Excel 2010 and the descriptive analysis and statistical test were conducted with software R 3.3.2. Results The diagnosis consistent rate of the 377 brucellosis cases reviewed was 70.8% (267/377), the diagnosis consistent rates in medical institutions at city-level and country-level were 77.0%(127/165) and 66.0%(140/212) respectively, the differences had significance (χ2=5.4, P=0.02). Among the reviewed cases, the diagnosis consistent rate of laboratory diagnosis and clinical diagnosis were 87.1%(256/294) and 13.3%(11/83) respectively, and the differences had significance (χ2=170.7, P<0.001) . Among the 21 investigated clinical doctors, the numbers of the doctors who correctly diagnosed the suspected cases, probable cases and lab-confirmed cases were only 3, 0 and 8 respectively. All of the clinical doctors knew that it is necessary to report the brucellosis cases within 24 hours after diagnosis. Conclusion The accuracy of human brucellosis diagnosis in key areas of human brucellosis in Shanxi was low, and the performance of the clinical doctors to diagnose human brucellosis according to diagnostic and case classification criteria was unsatisfied.