Objective To evaluate intra- and interatrial asynchrony and its determinants in aged patients with paroxysmal atrial fibrillation (PAF) by using tissue Doppler imaging. Methods Ninty-one patients without PAF (control group, including 40 elder patients and 51 non-elder patients) and 52 aged patients with PAF were included. As to assessment of intra- and interatrial synchronicity, the atrioventricular plane were selected on the right atrial (RA) free wall, interatrial septum (IAS), and left atrial (LA) free wall. The time differences from the onset of the P wave to the onset of the A wave at the left atrium (P-LA), the IAS (P-IAS), and the right atrium (P-RA) were measured. Intra-atrial asynchrony was defined as the differences between P-IAS and P-RA (RA asynchrony) and between P-LA and P-IAS (LA asynchrony). Interatrial asynchrony was defined as the difference between P-LA and P-RA. Stepwise regression was made to determine the influencing factors for atrial asynchrony in aged patients with PAF. Results Compared with the control group, aged patients with PAF had significant LA and interatrial asynchrony (P＜0.01). Multivariate stepwise regression demonstrated that systolic blood pressure (x2), age (x1) and left ventricular mass index (LVMI x5) entered the regression equation in aged patients with PAF (Y=-57.241+0.481 x1+0.223 x2+0.294 x5). Conclusions Aged patients with PAF have LA and interatrial asynchrony. LVH, aged and SBP are important factors leading to these asynchronies in the aged patients with PAF.

BACKGROUND: Previous studies have verified that under normal culture of neural stem cells (NSCs), folic acid can accelerate proliferation of NSCs by phosphorylation of mitogen activated protein kinase path activation ERK1/2. OBJECTIVE: To investigate the effect of folic acid on NSC extracellular signal regulatory protein kinase pERK1/2 under hypoxic condition. METHODS: NSCs from Neonatal rats were cultured in vitro by serum-free culture method, and incubated in a flask at 1×10~8/L. Except normal control group, self-made hypoxia equipment was used in the hypoxia model, folic acid deficiency and folic acid supplemented groups at day 3. At 37 ℃, hypoxia culture was conducted in the thermostat for 6 hours. The contents of folic acid were 4 mg/L, 4 mg/L, 0.65 mg/L, 8 mg/L in the four groups. Cells following 6 days were collected to count the density using trypan blue. RT-PCR was utilized to detect pERK1/2 mRNA expression. Western blot assay was employed to determine pERK1/2 protein expression. RESULTS AND CONCLUSION: Compared with the normal control group, the proliferation of NSCs and the expression of ERK1/2mRNA and pERK1/2 protein were decreased significantly in the hypoxia model group. Compared with the hypoxia model group, the proliferation of NSCs and the expression of ERK1/2mRNA and pERK1/2 protein were increased in the folic acid supplemented group, whereas decreased in the folic acid deficiency group. There were significant differences among groups (P < 0.001). Above-described results verified that folic acid supplementation can activate ERK1/2 phosphorylatin and accelerate proliferation of NSCs under hypoxia condition.

Objective To study the effects of folate(Fol) on proliferation,apoptosis and the antioxidative capacity of the NSCs under hypoxia in vitro.Method The NSCs taken from infant rats brain were cultured by serum-free medium in vitro and divided into four group which were normal control group(NC),hypoxia group(Hyp),Hpy+Fol-D(folate deficient)group and Hpy+Fol group.Except NC group,the other groups were cultured in hypoxia condition for 6 h.The proliferation of NSCs after hypoxia damage was detected by MTT test.The NSCs were collected after being cultured 6 d and then the activity of SOD and GSH-PX was examined.The expression of activated caspase-3 was detected by Western blot.Results Compared with NC group,the proliferation of NSCs and the activity of SOD and GSH-PX decreased significantly after hypoxia,while the expression of activated caspase-3 increased0 The proliferation of NSCs and the activity of SOD and GSH-PX in Hyp group were significantly higher than Hyp+Fol-D group but much lower than Hpy+Fol group(P

Objective To examine the reliability and validity of the Chinese version of the metacognition assessment scale 2009 (MAS-R 2009).Methods Sixty college students from a medical university in Shenyang were enrolled in the study.All the subjects were required to fill in the basic information questionnaire,IRI-C,SPM,and the Chinese version of the MAS-R 2009 and had to be interviewed.Two to four weeks later,6 college students were randomly selected to be interviewed again.Results Cronbach'sα coefficient of the Chinese version of MAS-R 2009 was 0.934,test-retest reliability of the scale was 0.935 (r ＜ 0.01),and inter-rater reliability of the scale was 0.832 (P ＜ 0.01).The Chinese version of the MAS-R 2009 had good content validity.The correlation coefficient between the items and the subscales in MAS-R 2009 showed high correlation,and the correlation coefficient ranged from 0.456 to 0.905.Conclusion The results indicate that the reliability and validity of the Chinese version of the revised metacognitive assessment scale 2009 has satisfied the psychometric requirements.It has a certain application value for domestic research and scientific research on the ability of mentalization.

Objective Establishing intelligent nursing clinical decision support system to improve the safety, quality and efficiency of clinical nursing work. Methods Guided by the HIMSS EMRAM Analytics stage 7 evaluation standard, the nursing decision support system is continuously improved through the establishment of knowledge bases such as nursing plans and nursing conventions. Results By comparing the writing time of nursing documents, the correct rate of nursing diagnosis, and the incidence of nursing risk events before and after the used of the system, the results showed that after the used of the nursing decision-making support system, whole hospital′s writing time could save 222.5 hours per day, improved accuracy of nursing diagnosis from 68.33％ (205/300)to 90.67％ (272/300), the difference was statistical significace (χ2=45.907, P<0.05). Decreased incidents, hospital-wide, on falls from 0.127‰(80/631702) to 0.071‰(45/638715),and on pressure ulcer form 0.064‰ (41/631702)to 0.028‰(18/638715), the difference was statistical significace (χ2=13.004～15.071, P<0.05). Conclusion Nursing clinical decision support system is the trend of hospital informatization and is worthy of clinical application.

Objective:To retrieve, evaluate, and integrate the best evidence for the management of neurogenic bowel dysfunction (NBD) in spinal cord injury patients both domestically and internationally, providing a basis for relevant evidence-based practices.Methods:The guidelines, expert consensus, clinical decision-making, and systematic review of NBD management for spinal cord injury patients were electronically searched in various databases and professional association websites at home and abroad. The search period was from database establishment to March 31, 2023.Results:A total of 13 articles were included, including five guidelines, five evidence summaries, two expert consensus, and one clinical decision-making. A total of 33 recommendations for NBD management in spinal cord injury patients were summarized from five aspects of medical history assessment, medication management, physical therapy, diet and exercise, and health education.Conclusions:The best evidence for NBD management in spinal cord injury patients summarized is scientific and practical. Medical and nursing staff should selectively apply the best evidence based on clinical practice.

Objective:To explore the current situation of psychological resilience and emergency rescue knowledge, attitudes and practice of pediatric nurses during public health emergencies, and analyze the influencing factors of psychological resilience, aiming at providing a basis for nursing managers to formulate strategies to improve psychological resilience, so as to further improve nursing staff's response to public health emergencies level.Methods:This study was a cross-sectional study. From February to April 2020, convenience sampling was adopted to select the pediatric nurses of the national children's hospitals or general hospitals as the research object. The General Information Questionnaire, the Connor-Davidson Resilience Scale (CD-RISC) and the Knowledge, Attitude and Practice Questionnaire for Medical Practitioners about Emergency Rescue of Public Health Events were used for investigation. A total of 13 091 questionnaires were distributed, and 12 750 valid questionnaires were returned with the valid response rate of 97.4%.Results:Among 12 750 nurses, the total score of CD-RISC was (65.53±15.55) . Multiple stepwise regression analysis showed that age, fertility, position, title, years of pediatric work, economic zone of the hospital, basic knowledge, psychological knowledge, other knowledge, emergency rescue attitude and emergency rescue practice were the main influencing factors of the psychological resilience of pediatric nurses during public health emergencies ( P<0.05) . Conclusions:The psychological resilience level of pediatric nurses in my country during public health emergencies needs to be improved. We should pay attention to nurses ≤40 years old, have no child, junior professional title, no positions, 6-10 years of pediatric work, and in the western region, and strengthen emergency rescue basic knowledge, psychological knowledge and other knowledge training, and improve their emergency rescue attitudes and behaviors, so as to improve the psychological resilience of pediatric nurses during public health events.

Objective:To retrieve and analyze evidence on exercise-related hypoglycemia prevention in children with type 1 diabetes mellitus (T1DM) and summarize the best evidence.Methods:BMJ Best Practice, UpToDate, NICE, JBI, SIGN, Cochrane Library, RNAO, IDF, ADA, Web of Science, PubMed, Embase, Medlive, Wanfang database, China National Knowledge Infrastructure (CNKI) and China Biology Medicine disc (CBM) were searched by computer for guidelines, evidence summary, recommended practice, systematic review, clinical decision-making and expert consensus on the prevention of exercise-related hypoglycemia in children with T1DM in the recent 6 years (2015-2020) .Results:A total of 13 papers were included, including 6 guidelines, 3 expert consensus papers and 4 clinical decision papers. Finally, 32 pieces of best evidence were formed, including 7 aspects such as characteristics of exercise-related hypoglycemia, the prevention strategies of hypoglycemia before, during and after exercise, and nocturnal hypoglycemia, hypoglycemia prevention strategies and health education.Conclusions:The best evidence of exercise-related hypoglycemia prevention strategy for T1DM children selected in this study is comprehensive and specific, based on which nursing staff can conduct health education on exercise-related hypoglycemia prevention for out-of-hospital type 1 diabetes children and their parents.

Objective:To analyze the status quo and influencing factors of post-traumatic growth of parents of children and adolescents with type 1 diabetes mellitus (T1DM) .Methods:The convenient sampling method was used to select parents of children with T1DM who were admitted to the diabetes care consultation clinic of Beijing Children's Hospital, Capital Medical University from March 2022 to March 2023 as the research objects. The parents of children were investigated by general information questionnaire, Posttramnatic Growth Inventory, Simplified Coping Style Questionnaire and Perceived Social Support Scale.Results:A total of 200 questionnaires were sent out in this study, and 187 were effectively collected, with an effective recovery rate of 93.5% (187/200). The total score of Posttramnatic Growth Inventory for parents of T1DM children was (60.28±18.37). The positive coping score in Simplified Coping Style Questionnaire was (22.40±6.94) and the negative coping score was (8.94±4.58). The total score of Perceived Social Support Scale was (57.39±14.57). The results of multiple linear regression analysis showed that HbA1c, monthly family income, educational level, positive coping strategies and perceived social support were the influencing factors for the post-traumatic growth of parents of T1DM children, explaining 33.8% of the variation in post-traumatic growth of parents of T1DM children.Conclusions:The post-traumatic growth of parents of T1DM children is at a moderate level. Medical staff should pay more attention to parents of children with poor blood sugar control, low educational level and low monthly family income, guide them from the perspective of positive psychology, encourage parents to adopt positive and effective coping strategies and emphasize the importance of social support, so as to improve the level of post-traumatic growth of parents of children with T1DM.

Objective:To investigate the incidence and influencing factors of allergic reactions to cephalosporins.Methods:A cross-sectional study of 29 medical institutions in Zhejiang Province was conducted from April 2021 to June 2021.The incidence of allergic reactions to cephalosporins was investigated,and the influencing factors of cephalosporin-induced allergic reactions were analyzed by Poisson regression.Results:A total of 56 155 patients were included in this study.The total incidence of allergic reactions to cephalosporin was 1.67‰,the highest incidence of anaphylaxis occurred for ceftizoxime(4.27‰),followed by ceftriaxone(3.49‰)and cefotaxime(2.40‰).There was no significant difference in the incidence of allergic reactions between patients with negative skin tests and those without skin tests(1.75％o vs.1.63‰,RR=1.07,95％CI:0.70-1.63,P＞0.05).Poisson regression showed that body mass index(BMI)＜18.5 kg/m2(RR=2.43,95％CI:1.23-4.82,P＜0.05)and history of β-lactam antibiotics allergy(RR=33.88,95％CI:1.47-781.12,P＜0.05)increased cephalosporin-induced anaphylaxis.Compared with cefuroxime,the risk of allergic reactions was increased for ceftriaxone(RR=3.08,95％CI:1.70-5.59,P＜0.01),ceftazidime(RR=1.89,95％CI:1.03-3.47,P＜0.05),and ceftizoxime(RR=3.74,95％CI:1.64-8.50,P＜0.01).Conclusions:Lower BMI and history of β-lactam antibiotics allergy increase the risk of cephalosporin allergic reactions.The routine skin test may not reduce the occurrence of allergic reactions to cephalosporins. This study has been registered at Chinese Clinical Trial Registry(ChiCTR2200064314).