Objectives To explore the establishment and effects of a multilevel and inter-disciplinary management scheme for specialist nurses.Methods The multilevel and inter-disciplinary management scheme included establishing the pyramid hierarchical training model,exploring superimposed training mechanism for specialist nurses with horizontal expansion,vertical extension,and deep development,and constructing stereoscopic clinical evaluation and quantitative assessment system.Four hundred-forty two specialized nurses have been recruited to join the multilevel and inter-disciplinary management scheme from July 2021 to August 2023.The core competencies of specialized nurses were compared before and after the implementation of management scheme.Results The quality development of specialized nursing have been improved,and the total scores and the scores of 3 dimensions(research innovation,management,and professional development)in core competencies of specialized nurses after the intervention of multilevel and inter-disciplinary management scheme were higher than those before(P＜0.05).Conclusion The multilevel and inter-disciplinary management scheme can effectively improve the core competencies of specialized nurses,and promote the high-quality development of specialized nursing.

The pursuit of cosmetic effects in post-surgical wounds has led to the development of ultra-minimally invasive techniques in surgery. Minimal invasive surgery has replaced open surgery and has become the new gold-standard for treating diseases. One such technique is the single incision triangulated umbilicus surgery (SITUS), which offers several advantages over traditional laparoscopic and other scarless surgeries, including reduced trauma, faster recovery, and better cosmetic outcomes. SITUS also has a short learning curve, aligns with conventional instrumentation operating habits, and can be used for whole abdominal surgeries. Chinese scholars have made further improvements to the SITUS technology, including expanding its applicability in intra-abdominal surgery and refining its incision closure methods to achieve superior cosmetic results. Currently, SITUS technology is experiencing rapid development in urology applications and has demonstrated satisfactory results in both domestic and international reports. This review aims to discuss the effectiveness and development of the SITUS technique in urology.

Objective:To develop and evaluate the efficacy and safety of a three-dimensional (3D) digestive endoscope for gastric endoscopic submucosal dissection (ESD) through animal experiments.Methods:Two Dutch pigs were utilized from the Zhengzhou University Animal Experiment Center for the study. ESD procedures were performed by two senior endoscopists, one using 3D glasses and the other utilizing a 3D high-definition head display. The success of ESD was assessed based on predefined criteria, including completion of surgical steps, complete detachment of the presumptive lesion, and effective bleeding control during and after the surgery. The number of successful procedures and incidences of perforation were recorded. The stereoscopic experience of the endoscopists, including both the primary endoscopist and the assistant, was also evaluated. Furthermore, the assessment encompassed any reported symptoms of eye discomfort, such as eye fatigue, ocular pain, and blurred vision. Additionally, the confidence level of the endoscopists in the mechanical aspects of the operation, as well as encountered issues during the endoscopic procedures, were documented.Results:Two ESD were successful and no perforation occurred. Feedback from endoscopists suggested that 3D digestive endoscopy offered clear images with enhanced three-dimensionality during surgery, clear sense of distance and layering, allowing for a precise judgment of bleeding points, which surpassed 2D capabilities. No eye discomfort was experienced by endoscopists or assistants during or after the procedures. While endoscopists exhibited high confidence in 3D digestive endoscopy, they noted issues with image blurring when the camera was positioned less than 10 mm from the gastrointestinal tract wall.Conclusion:Preliminary results show that 3D digestive endoscopes can provide excellent stereo imaging, improved positioning accuracy, and safety during live animal stomach ESD procedures, without significantly increasing endoscopists' eye discomfort. Nevertheless, efforts are needed to address image blurring concerns when the camera is close to the gastrointestinal tract wall.

Objective To investigate the protective effect of target temperature management based different durations with delayed hypothermia for traumatic brain injury(TBI)in rats.Methods 36 healthy adult male SD rats were randomly divided into NT group,HT4h group,HT24h group and HT48h group.The TBI model of rats was prepared with an electronic controllable cortical injury device.NT group was treated with normal temperature(37℃)4 h after TBI,and the experimental groups were treated with low temperature(33.0±1.0℃)4 h after TBI for 4 h,24 h,and 48 h.Three days after TBI,the motor function of the rats in each group was evaluated by beam walking test and inclined-grid climbing test,EB staining was used to measure the blood-brain barrier perme-ability,the change of hippocampal neurons was observed by Nissl staining,the expression of DCX and GFAP was detected by immunofluorescence,and the expression of Bcl-2 and Bax was measured by Western blot and immuno-histochemistry.Results Compared with NT group,the experimental groups could significantly improve the motor function of TBI rats,reduce the permeability of blood-brain barrier,protect hippocampal neurons,promote DCX expression,inhibit GFAP expression,up-regulate the expression of Bcl-2 protein,and down-regulate the expres-sion of Bax protein.However,the protective effect was more apparent in HT48h group than other experimental groups(P<0.05).Conclusion Long-term delayed target temperature management has a significant brain protective effect.

Objective:To investigate the effect of ultrasound-guided thoracic paravertebral nerve block (TPNB) on anesthesia efficacy and stress response in middle-aged and elderly patients undergoing radical surgery for lung cancer.Methods:A total of 104 lung cancer patients who underwent thoracoscopic radical resection for lung cancer at Qingdao Traditional Chinese Medicine Hospital from November 2020 to May 2023 were selected and randomly divided into an observation group (52 cases) and a control group (52 cases) using a random number table method. The observation group received general anesthesia combined with ultrasound-guided TPNB anesthesia during surgery, while the control group received general anesthesia. Two groups of patients were compared in terms of surgical time, intraoperative blood loss, remifentanil and propofol dosage, fluctuation trends of mean arterial pressure (MAP) and heart rate (HR), pain levels in resting and coughing states after surgery, differences in serum stress response indicators [fasting plasma glucose (FPG), cortisol (Cor), norepinephrine (NE), epinephrine (E)] before and after surgery, and adverse reactions.Results:There was no statistically significant difference in surgical time, intraoperative blood loss, and single lung ventilation time between the observation group and the control group (all P>0.05). The usage of remifentanil and propofol in the observation group was lower than that in the control group, and the difference was statistically significant (all P<0.05). The MAP fluctuation changes at four time points before anesthesia induction, 30 minutes during surgery, 90 minutes during surgery, and after surgery in the observation group were smaller than those in the control group. Among them, the MAP at 30 minutes during surgery and 90 minutes during surgery was higher than that in the control group (all P<0.05); There was no statistically significant difference in HR fluctuations between the observation group and the control group at the four time points (all P>0.05). The Visual Analog Scale (VAS) scores of the observation group patients in resting and coughing states at 12 and 24 hours after surgery were lower than those of the control group at the same time point (all P<0.05). The serum Cor and E levels in the observation group were lower than those in the control group at 12 hours after surgery, and the serum NE levels were lower than those in the control group at 12 and 24 hours after surgery (all P<0.05). The incidence of adverse reactions caused by anesthesia in the observation group was lower than that in the control group ( P<0.05). Conclusions:The use of ultrasound-guided TPNB combined with general anesthesia in patients undergoing radical surgery for lung cancer is beneficial in reducing intraoperative blood pressure fluctuations, alleviating postoperative pain and stress response, and reducing adverse reactions caused by anesthesia.

The occurrence of cervical cancer in women is closely related to high-risk HPV infection, and timely and effective interruption of high-risk HPV infection is of great significance to prevent the occurrence of cervical cancer. Huang Yuanyou's theory of "circular flow of Qi" emphasizes on the harmonization of the overall Qi flow, which can explain the physiopathology of women. The occurrence of high-risk HPV infection is related to the loss of spleen and earth transportation in the middle Jiao, poor circulation of Qi, and the low resistance of the body to evil, resulting in the malfunctioning of clear and turbid. Based on the theory of "circular flow of Qi" combined with the idea of "prevention treatment of disease", the author proposes to "prevent the disease before it occurs, regulate the middle earth to preserve the correct Qi" and "prevent the disease before it occurs". The principles of prevention and treatment of high-risk HPV infection are "prevent before the disease, regulate the middle earth to preserve the righteousness", "promote and descend to dispel the poisonous evil", and "prevent recurrence after the disease, balance yin and yang and harmonize Qi and blood", in order to provide reference for clinical treatment.

Objective:To study the risk factors of venous thromboembolism(VTE)and the predictive value of the improved VTE score model to identify the risk of VTE in gynecological surgery patients.Methods:From Janu-ary 1,2020 to December 31,2022,41 patients with VTE after gynecological surgery were selected as the VTE group,and a total of 164 patients with adjacent gynecological surgeries during the same period were selected as the non-VTE group with a ratio of 1 :4.Univariate and multivariate Logistic regression analysis were used to ana-lyze the risk factors of VTE after gynecological surgery,and a modified VTE risk factor rapid assessment model(referred to as the improved VTE score model)was constructed.The receiver operating characteristic(ROC)curve was used to study the predictive value for VTE for in gynecological surgery,and compared with the Caprini score model(Caprini table for short).Results:①Multivatiate Logistic regression analysis showed that there were independent risk factors for postoperative VTE in gynecology surgery(OR＞1,P＜0.05),including age≥60 years,BMI≥28 kg/m2,malignant tumors,surgery time＞3 hours,history of thrombosis,and the increased D-di-mer difference before and after surgery.②The Area under Curve(AUC)of ROC was 0.963 in the improved VTE score model with a Youden index 81.10％,sensitivity 87.80％and specificity 93.29％.The AUC of the Caprini score model was 0.888 with Youden index 63.41％,sensitivity 73.17％and specificity 90.24％.The improved VTE score model the Caprini score model identified 92.68％and 85.37％of VTE patients as high-risk or ex-tremely high-risk,respectively,but the difference was not statistically significant(P＜0.05).Conclusions:More attention should be paid to the six independent risk factors for postoperative VTE in gynecology surgery.The two score models showed a similar identified level.However,the improved VTE score model is more simple and easier to operate,has better practicality,and has certain clinical promotion value.

Objective: To understand the attitudes and perceptions of traditional Chinese medicine (TCM) practitioners in Beijing TCM hospitals regarding the use of Ephedra sinica Stapf (E. sinica, Ma Huang). Methods: A two-stage cross-sectional study was conducted using a questionnaire survey of TCM practitioners in Beijing TCM hospitals between April 2023 and March 2024. The questionnaire included demographic information, the clinical background of TCM practitioners, and the clinical application of E. sinica. Logistic regression analysis was used to analyze the relevant influencing factors when using E. sinica. Results: Of the 465 questionnaires collected, 441 were valid. Among these, 84.81% (374/441) reported having used E. sinica in clinical practice at least once. The commonly used doses of E. sinica—excluding the pediatric department—were 10 g for high doses, 6 g for medium, and 3 g for low. The three most frequently used formulas for E. sinica included Maxing Shigan decoction, Mahuang decoction, and Xiao Qing Long decoction. The most common TCM patterns treated with a high dose of E. sinica were wind-cold exterior pattern, wind-cold invading the lung, and wind and water combat with meridians congealed by cold. The top three Western medical diagnoses when using E. sinica for treatment were common cold, pneumonia, and upper respiratory tract infections. Nearly half of the respondents reported experiencing adverse reactions from the oral administration of E. sinica, with the most common being palpitations, insomnia, and restlessness. Starting with a low dose and gradually increasing it as appropriate was identified as an effective approach. Conclusion This study investigated the attitudes and perceptions of TCM practitioners in Beijing TCM hospitals regarding the dose–efficacy–adverse reaction relationship of E. sinica, providing a reference for the safe and effective clinical use of E. sinica.

Objective:To develop a robotic digestive endoscope system (RDES) and to evaluate its feasibility, safety and control performance by experiments.Methods:The RDES was designed based on the master-slave control system, which consisted of 3 parts: the integrated endoscope, including a knob and button robotic control system integrated with a gastroscope; the robotic mechanical arm system, including the base and arm, as well as the endoscopic advance-retreat control device (force-feedback function was designed) and the endoscopic axial rotation control device; the control console, including a master manipulator and an image monitor. The operator sit far away from the endoscope and controlled the master manipulator to bend the end of the endoscope and to control advance, retract and rotation of the endoscope. The air supply, water supply, suction, figure fixing and motion scaling switching was realized by pressing buttons on the master manipulator. In the endoscopy experiments performed on live pigs, 5 physicians each were in the beginner and advanced groups. Each operator operated RDES and traditional endoscope (2 weeks interval) to perform porcine gastroscopy 6 times, comparing the examination time. In the experiment of endoscopic circle drawing on the inner wall of the simulated stomach model, each operator in the two groups operated RDES 1∶1 motion scaling, 5∶1 motion scaling and ordinary endoscope to complete endoscopic circle drawing 6 times, comparing the completion time, accuracy (i.e. trajectory deviation) and workload.Results:RDES was operated normally with good force feedback function. All porcine in vivo gastroscopies were successful, without mucosal injury, bleeding or perforation. In beginner and advanced groups, the examination time of both RDES and ordinary endoscopy tended to decrease as the number of operations increased, but the decrease in time was greater for operating RDES than for operating ordinary endoscope (beginner group P=0.033; advanced group P=0.023). In the beginner group, the operators operating RDES with 1∶1 motion scaling or 5∶1 motion scaling to complete endoscopic circle drawing had shorter completion time [1.68 (1.40, 2.17) min, 1.73 (1.47, 2.37) min VS 4.13 (2.27, 5.16) min, H=32.506, P<0.001], better trajectory deviation (0.50±0.11 mm, 0.46±0.11 mm VS 0.82±0.26 mm, F=38.999, P<0.001], and less workload [42.00 (30.00, 50.33) points, 43.33 (35.33, 54.00) points VS 52.67 (48.67, 63.33) points, H=20.056, P<0.001] than operating ordinary endoscope. In the advanced group, the operators operating RDES with 1∶1 or 5∶1 motion scaling to complete endoscopic circle drawing had longer completion time than operating ordinary endoscope [1.72 (1.37, 2.53) min, 1.57 (1.25, 2.58) min VS 1.15 (0.86, 1.58) min, H=13.233, P=0.001], but trajectory deviation [0.47 (0.13, 0.57) mm, 0.44 (0.39, 0.58) mm VS 0.52 (0.42, 0.59) mm, H=3.202, P=0.202] and workload (44.62±21.77 points, 41.24±12.57 points VS 44.71±17.92 points, F=0.369, P=0.693) were not different from those of the ordinary endoscope. Conclusion:The RDES enables remote control, greatly reducing the endoscopists' workload. Additionally, it gives full play to the cooperative motion function of the large and small endoscopic knobs, making the control more flexible. Finally, it increases motion scaling switching function to make the control of endoscope more flexible and more accurate. It is also easy for beginners to learn and master, and can shorten the training period. So it can provide the possibility of remote endoscopic control and fully automated robotic endoscope.

Helicobacter pylori(Hp)is responsible for chronic gastritis,peptic ulcers,and even gastric cancers.Currently,there is no vaccine to prevent or treat Hp infections.Here,we described the chemical synthesis of α-1,6-glucans with different lengths(di-to hexasaccharide),which are present in the core oligosaccharide of Hp lipopolysaccharide(LPS).The 1,2-cis-glucosidic bonds were constructed successfully using a synergistic glycosylation strategy based on acyl remote participation and solvent effects.The results of glycan microarrays indicated that all synthesized α-1,6-glucan fragments possessed a strong binding to IgG antibodies in both rabbit serum immunized with Hp O1 LPS and patient serum infected with Hp.The α-1,6-linked trisaccharide exhibited strong binding affinity to anti-LPS rabbit IgG antibodies.The α-1,6-glucan trisaccharide and pentasaccharide elicited a strong response to IgG antibodies in sera of most Hp-infected patients.Some patients'sera exhibited strong binding activity with α-1,6-linked disaccharide.The results suggest that the α-1,6-glucan disaccharide,trisaccharide and pentasaccharide could be important carbohydrate antigen fragments in Hp lipopolysaccharide.