Objective To understand the facilitating and obstacle factors for pediatric nurses in implementing interventions for children's medical fears and to provide a foundation for exploring intervention strategies for pediatric nurses to effectively tackle children's medical fears.Methods By purposive sampling,face-to-face interviews were conducted with 20 pediatric nurses in a tertiary-level A children's hospital in Wenzhou City from December 2023 to February 2024.Traditional content analysis was used for data analysis.Results Facilitators and obstacle factors to the implementation of medical fear interventions by pediatric nurses were extracted.The 4 sub-themes of the facilitator theme include awareness of the importance of medical fear intervention,the drive of individual empathy,positive peer support,and the construction of a suitable hospital environment.The 3 sub-themes of the obstacle theme include the lack of individualized intervention skills for medical fear,heavy workload,interference from negative emotional behavior of family members.Conclusion There are many factors influencing paediatric nurses to implement medical fear interventions for children.It is recommended that clinical nursing administrators should strengthen the systematic training of pediatric nurses'knowledge about medical fear interventions for children,unite with multidisciplinary experts,and recruit medical social workers or volunteers to collaborate with nurses and children's families to cope with children's medical fears together and to promote physical and mental health of hospitalized children.

Objective To establish atopic dermatitis(AD)-like models in BALB/c mice using three chemical inducers,calcipotriol(MC903),2,4-dinitrochlorobenzene(DNCB),and oxazolone(OXA),and to explore the occurrence of ferroptosis in the different models.Methods Healthy 7-week-old female BALB/c mice were divided randomly into eight groups(n=8 mice per group)based on the induction site(ear/dorsal skin)and inducer:ear/dorsal control groups,MC903 ear/dorsal model groups,DNCB ear/dorsal model groups,and OXA ear/dorsal model groups.Models were established by topical application of the respective agents at specified concentrations.Mice in the MC903 ear/dorsal groups underwent continuous induction for 14 d.Mice in the DNCB and OXA ear/dorsal groups were sensitized for 3 consecutive days,4 days after the sensitization was completedand then challenged 12 times on day 8 and every other day for up to day 30.Skin lesions were observed and skin thickness was measured.Plasma levels of reactive oxygen species(ROS),interleukin(IL)-4,interferon(IFN)-γ,and malondialdehyde(MDA)were detected,the skin was examined by histopathological staining and ultrastructural observation,and expression levels of ferroptosis-related proteins(glutathione peroxidase 4(GPX4),ferritin heavy chain 1(FTH1),long-chain-fatty-acid-CoA ligase 4(ACSL4),transferrin receptor 1(TfR1))were detected by Western Blot.Results Compared with each control mice,all model mice exhibited obvious redness,swelling,scratching,desquamation,and rough thickening of the skin,and skin thickness was significantly increased(P＜0.01).ROS,IFN-γ,IL-4,and MDA levels were elevated to varying extents(P＜0.05)and histopathological features,including epidermal hyperplasia,keratinocyte degeneration,dermal vascular congestion,and immune cell infiltration,were detected in model mice.Transmission electron microscopy also revealed mitochondrial membrane rupture,increased density,and cristae reduction.Expression levels of ferroptosis markers were dysregulated,including significantly decreased GPX4/FTH1(P＜0.05)and increased ACSL4/TfR1 expression(P＜0.05).Conclusions All three chemicals successfully induced AD-like phenotypes in BALB/c mice through site-specific applications.Ferroptosis is involved in the pathological process of AD,but heterogeneity exists among inducers and modeling sites.

Objective To establish dynamic nomogram models for postoperative recurrence and survival risk of patients with AFP-negative hepatocellular carcinoma(ANHC)based on multimodal clinical data,to identify ANHC-specific prognostic biomarker combinations by integrating tumor biological characteristics and treatment response parameters through machine learning,and to provide an individualized risk assessment tool for overcoming the limitations of traditional serum biomarkers.Methods A retrospective analysis was performed for 421 ANHC patients who underwent hepatectomy in Eastern Hepatobiliary Surgery Hospital from April 2012 to December 2018,and they were randomly divided into training group with 210 patients and validation group with 211 patients.The univariate and multivariate Cox proportional-hazards regression models were used to identify independent prognostic factors and establish a nomogram model,and the receiver operating characteristic(ROC)curve,the calibration curve,and the decision curve analysis were used to assess the performance of the model.Related indicators were measured,including prealbumin(PA),white blood cell count(WBC),tumor size,and microvascular invasion.The chi-square test or the Fisher's exact test was used for comparison of categorical variables between two groups,and the independent-samples t test or the Mann-Whitney U test was used for comparison of continuous variables between two groups.Results The multivariate analysis showed that multiple tumors(hazard ratio[HR]=3.30,P<0.001),WBC(HR=1.05,P=0.005),blood glucose(HR=1.15,P=0.026),CA19-9(HR=1.17,P=0.005),and tumor size(HR=1.17,P<0.001)were independent risk factors for disease-free survival(DFS),while PA(HR=0.99,P=0.022)was a protective factor.Incomplete tumor capsule(HR=0.60,P=0.009),age(HR=1.02,P=0.035),prothrombin time(PT)(HR=1.27,P=0.023),CA19-9(HR=1.01,P<0.001),and tumor size(HR=1.15,P<0.001)were independent risk factors for overall survival(OS).The DFS nomogram achieved an AUC of 0.74(95%confidence interval[CI]:0.64-0.84)in the training group and 0.67(95%CI:0.57-0.77)in the validation group,while the OS nomogram had an AUC of 0.76(95%CI:0.64-0.88)and 0.73(95%CI:0.60-0.87),respectively.The calibration curve and the decision curve analysis showed that the models had good predictive accuracy and clinical practicability.Conclusion Preoperative indicators,including tumor number,PA,WBC,and tumor size,can effectively predict postoperative recurrence in ANHC patients,while tumor capsule integrity,age,and PT are significantly associated with OS.The nomogram models established have good performance and can provide a basis for individualized prognostic assessment.

A tertiary public general hospital in Guangdong has innovated its inpatient bed scheduling system by integra-ting multiple models,including"Hospital-Wide Bed Pooling,"outpatient chemotherapy,day surgery,pre-admission,and pre-discharge programs.Supported by policy guidance,this initiative optimizes clinical operations,enhances patient admission struc-tures and processes,and improves bed utilization efficiency through a multi-dimensional centralized bed management approach.By rationally allocating hospital-wide bed resources and maximizing their operational effectiveness,the hospital advances high-quality development in healthcare delivery.

Objective To establish dynamic nomogram models for postoperative recurrence and survival risk of patients with AFP-negative hepatocellular carcinoma(ANHC)based on multimodal clinical data,to identify ANHC-specific prognostic biomarker combinations by integrating tumor biological characteristics and treatment response parameters through machine learning,and to provide an individualized risk assessment tool for overcoming the limitations of traditional serum biomarkers.Methods A retrospective analysis was performed for 421 ANHC patients who underwent hepatectomy in Eastern Hepatobiliary Surgery Hospital from April 2012 to December 2018,and they were randomly divided into training group with 210 patients and validation group with 211 patients.The univariate and multivariate Cox proportional-hazards regression models were used to identify independent prognostic factors and establish a nomogram model,and the receiver operating characteristic(ROC)curve,the calibration curve,and the decision curve analysis were used to assess the performance of the model.Related indicators were measured,including prealbumin(PA),white blood cell count(WBC),tumor size,and microvascular invasion.The chi-square test or the Fisher's exact test was used for comparison of categorical variables between two groups,and the independent-samples t test or the Mann-Whitney U test was used for comparison of continuous variables between two groups.Results The multivariate analysis showed that multiple tumors(hazard ratio[HR]=3.30,P<0.001),WBC(HR=1.05,P=0.005),blood glucose(HR=1.15,P=0.026),CA19-9(HR=1.17,P=0.005),and tumor size(HR=1.17,P<0.001)were independent risk factors for disease-free survival(DFS),while PA(HR=0.99,P=0.022)was a protective factor.Incomplete tumor capsule(HR=0.60,P=0.009),age(HR=1.02,P=0.035),prothrombin time(PT)(HR=1.27,P=0.023),CA19-9(HR=1.01,P<0.001),and tumor size(HR=1.15,P<0.001)were independent risk factors for overall survival(OS).The DFS nomogram achieved an AUC of 0.74(95%confidence interval[CI]:0.64-0.84)in the training group and 0.67(95%CI:0.57-0.77)in the validation group,while the OS nomogram had an AUC of 0.76(95%CI:0.64-0.88)and 0.73(95%CI:0.60-0.87),respectively.The calibration curve and the decision curve analysis showed that the models had good predictive accuracy and clinical practicability.Conclusion Preoperative indicators,including tumor number,PA,WBC,and tumor size,can effectively predict postoperative recurrence in ANHC patients,while tumor capsule integrity,age,and PT are significantly associated with OS.The nomogram models established have good performance and can provide a basis for individualized prognostic assessment.

BACKGROUND:Slow bone repair and poor bone formation quality are still problems during masquelet technique in the treatment of large segment bone defects.H-type vessels can induce osteogenesis,enhance the local angiogenesis and osteogenesis coupling,and promote bone repair.However,there are few reports on the role of H-type blood vessels in the bone induced membrane.OBJECTIVE:To construct a large segment bone defect model of SD rat tibia,observe the expression characteristics of H-type blood vessels in the bone induced membrane,then to identify the expression peak point of H-type blood vessels in the bone induced membrane and determine the optimal period of bone grafting.METHODS:Sixty SD rats were randomly divided into a control group(n=30)and a model group(n=30)by random number table method.The two groups were further divided into three subgroups at 4,6,and 8 weeks after bone cement implantation,with 10 rats in each group.A 4 mm bone defect model of the right tibia was constructed in both the control and the model groups.Polymethyl methacrylate bone cement was implanted in the model group to induce bone biomembrane formation,while bone cement was not implanted in the control group.At 4,6,and 8 weeks after bone cement implantation,6 rats were randomly selected at each time point.The bone induction membrane tissue was cut from the model group,and the non-bone soft tissue of the corresponding part was cut from the control group.The dynamic expressions of H-type blood vessels in the bone induced membrane were identified by immunofluorescence.The morphological changes of the bone induced membrane were observed by hematoxylin-eosin staining.The formation of blood vessels in the bone induced membrane was observed by angiography.The expression levels of osteoblast-specific transcription factor in the bone induced membrane were detected by immunohistochemistry.Four rats remained at each time point.In the model group,the bone induced membrane was cut open and the bone cement was removed and autologous coccyx was implanted.In the control group,autologous coccyx was implanted in the bone defect area.Micro-CT evaluation of the tibial defect was performed 8 weeks after bone grafting.RESULTS AND CONCLUSION:(1)Immunofluorescence staining showed that the expression of H-type vessels in the model group was most obvious 6 weeks after bone cement implantation,and the expression of H-type vessels in the model group at each time point after bone cement implantation was higher than that in the control group(P＜0.05).(2)Hematoxylin-eosin staining and angiography showed that the number and volume of new blood vessels at each time point after bone cement implantation in the model group were greater than those in the control group(P＜0.05).The order of the number and volume of new blood vessels in the model group was:8 weeks after bone cement implantation＞6 weeks after bone cement implantation＞4 weeks after bone cement implantation.(3)Immunohistochemical staining showed that the positive expression of osteoblast-specific transcription factors at each time point after bone cement implantation in the model group was higher than that in the control group(P＜0.05),and the positive expression of osteoblast-specific transcription factors in the model group was most obvious 6 weeks after bone cement implantation.(4)Micro-CT detection showed that the bone repair effect of the three subgroups in the model group was significantly better than that of the corresponding subgroups in the control group,and the bone repair effect of the subgroup in the model group 6 weeks after bone cement implantation was better than that of the subgroups 4 and 8 weeks after bone cement implantation.The results indicate that H-type blood vessels are dynamically expressed in the bone induced membrane and reached a peak 6 weeks after bone cement implantation.Good bone repair effects can be obtained by the bone induced membrane bone grafting 6 weeks after bone cement implantation.

A tertiary public general hospital in Guangdong has innovated its inpatient bed scheduling system by integra-ting multiple models,including"Hospital-Wide Bed Pooling,"outpatient chemotherapy,day surgery,pre-admission,and pre-discharge programs.Supported by policy guidance,this initiative optimizes clinical operations,enhances patient admission struc-tures and processes,and improves bed utilization efficiency through a multi-dimensional centralized bed management approach.By rationally allocating hospital-wide bed resources and maximizing their operational effectiveness,the hospital advances high-quality development in healthcare delivery.

Objective To investigate the predictive value of pulmonary artery(Pa)to aortic(Ao)diameter ratio(Pa/Ao)for long-term major adverse cardiovascular events(MACEs)in patients with acute decompensated heart failure(ADHF).Methods ADHF patients hospitalized in the Department of Cardiology of Nanjing Drum Tower Hospital from January 2018 to January 2023 were consecutively enrolled.The data of gender,age,past medical history,laboratory examination,echocardiography,chest CT and medication were collected.The diameters of Pa and Ao were measured at the bifurcation of main pulmonary artery on chest CT,and Pa/Ao was calculated.The Kaplan-Meier method was used for survival analysis,and the Log-rank test was used to compare the survival rate between the two groups.Cox proportional hazards regression model was used to analyze the association between Pa/Ao and MACEs,and subgroup analysis was performed according to different age,sex,BMI,B-type natriuretic peptide level,and left ventricular ejection fraction.Results A total of 600 ADHF patients were enrolled,with an average age of 69.6 years and 347(57.8%)males.During a median follow-up of 306(127,624)days,327(54.5%)patients experienced MACEs.The ADHF patients were divided into Pa/Ao<0.93 group and Pa/Ao≥0.93 group according to the analysis of maximum selection rank statistics.Kaplan-Meier curve showed that the incidence of MACEs in Pa/Ao≥0.93 group was significantly higher than that in Pa/Ao<0.93 group(PLog-rank<0.001).Multivariate Cox regression analysis showed that Pa/Ao was an independent predictor of MACEs in ADHF patients(HR=11.62,95%CI:4.91～27.50,P<0.001).Subgroup analysis showed that Pa/Ao had predictive value for different ADHF populations(all P<0.05).Conclusion Elevated Pa/Ao is a predictor of long-term MACEs in ADHF patients.

Objective To explore the distribution characteristics and influencing factors of nasal colonized bacteria of healthcare workers(HCWs)in pediatric intensive care unit(PICU).Methods A cross-sectional study was con-ducted.Nasal swab specimens from 104 HCWs in the PICU of a hospital were collected for bacterial culture and an-timicrobial susceptibility testing.According to the identification and antimicrobial susceptibility testing results of strains,distribution characteristics of colonized bacteria was analyzed.Basic information of studied subjects were collected through questionnaire survey,and risk factors for colonized bacterial infection were conducted using logis-tic regression analysis.Results Among 104 specimens,colonized bacteria were detected from 66 specimens,with an overall detection rate of 63.46％.Gram-positive bacteria was mainly Staphylococcus aureus,with a detection rate of 34.62％(n=36),out of which methicillin-resistant Staphylococcus aureus(MRSA)accounted for 2.88％(n=3).Gram-negative bacteria was mainly Klebsiella spp.,with a detection rate of 21.15％(n=22).Multiva-riate logistic regression analysis showed that HCWs with junior professional titles(OR=11.400,95％CI:2.329-55.801,P=0.003)was an independent risk factor for Staphylococcus aureus colonization,and male(OR=4.260,95％CI:1.160-15.653,P=0.029)was an independent risk factor for Klebsiella spp.colonization.Conclusion Nasal cavity of HCWs in PICU has a high detection rate of colonized bacteria,with Staphylococcus aureus and Klebsiella spp.being the major colonized bacteria.

Objective To explore the distribution characteristics and influencing factors of nasal colonized bacteria of healthcare workers(HCWs)in pediatric intensive care unit(PICU).Methods A cross-sectional study was con-ducted.Nasal swab specimens from 104 HCWs in the PICU of a hospital were collected for bacterial culture and an-timicrobial susceptibility testing.According to the identification and antimicrobial susceptibility testing results of strains,distribution characteristics of colonized bacteria was analyzed.Basic information of studied subjects were collected through questionnaire survey,and risk factors for colonized bacterial infection were conducted using logis-tic regression analysis.Results Among 104 specimens,colonized bacteria were detected from 66 specimens,with an overall detection rate of 63.46％.Gram-positive bacteria was mainly Staphylococcus aureus,with a detection rate of 34.62％(n=36),out of which methicillin-resistant Staphylococcus aureus(MRSA)accounted for 2.88％(n=3).Gram-negative bacteria was mainly Klebsiella spp.,with a detection rate of 21.15％(n=22).Multiva-riate logistic regression analysis showed that HCWs with junior professional titles(OR=11.400,95％CI:2.329-55.801,P=0.003)was an independent risk factor for Staphylococcus aureus colonization,and male(OR=4.260,95％CI:1.160-15.653,P=0.029)was an independent risk factor for Klebsiella spp.colonization.Conclusion Nasal cavity of HCWs in PICU has a high detection rate of colonized bacteria,with Staphylococcus aureus and Klebsiella spp.being the major colonized bacteria.