Myasthenia gravis is an autoimmune disorder characterized by impaired neuromuscular transmission. Thymectomy is one of the therapeutic options for acetylcholine receptor antibody-positive myasthenia gravis patients. The quality of perioperative care is directly associated with surgical safety and patient outcomes. However, there is currently a lack of specialized nursing consensus or guidelines specifically addressing the care of these patients domestically or internationally. To promote the standardization and normalization of perioperative nursing care for myasthenia gravis patients undergoing thymectomy and to ensure treatment efficacy, a panel of 57 experts from relevant fields was convened. Based on evidence-based medicine and clinical practice experience, discussions were held on various aspects including condition assessment, nutritional support, medication management, and airway care, resulting in a consensus with 18 final recommendations by using the Delphi method through two rounds of expert consultation. This consensus aims to provide a scientific reference for the perioperative nursing care of myasthenia gravis patients undergoing thymectomy.

Implementation science (IS) aims to systematically analyze and address the real-world gaps from evidence to practice and the influencing factors of the context. It is necessary to carry out qualitative research to gather relevant implementation outcomes. Nevertheless, traditional qualitative analysis has issues such as consuming a great deal of time and energy, and it is unable to promptly provide the crucial data required for implementation science research. The Rapid Qualitative Analysis (RQA) method, through semi-structured interviews and the adoption of techniques such as immediate data condensation and matrix analysis, can effectively shorten the cycle of qualitative data collection and data processing. RQA can promptly identify social determinants of health such as structural barriers, facilitators, and the behavioral characteristics of target groups. It provides a real-time basis for public health decision-making, the interpretation of complex social phenomena, and the process and effectiveness evaluation of research projects. Although RQA is difficult to conduct in-depth theoretical analysis based on grounded theory, its efficiency and flexibility make it the preferred tool for large-scale and time-sensitive research. Thus, it has been widely applied in implementation science research. This paper sorts out the core concepts and commonly used technical methods of RQA, as well as the differences between RQA and traditional qualitative analysis. It also explores the applications of RQA in intervention optimization, process evaluation, and implementation outcome evaluation. By integrating specific cases, this paper clarifies its application value in the field of implementation science. In the future, it is advisable to explore the integration of RQA with technologies such as artificial intelligence and big data, in order to bridge the gap between the transformation of scientific research achievements into practice. Under circumstances of limited resources or tight time constraints, RQA can be used to efficiently conduct implementation science research, providing convenient and scientific methodological and technical support for accelerating evidence-based practice.

Osteoarthritis (OA) causes chronic pain that significantly impairs quality of life, with current treatments often proving insufficient and accompanied by adverse effects. Recent research has identified the dorsal root ganglion (DRG) and its resident macrophages as crucial mediators of chronic OA pain through neuroinflammation driven by macrophage polarization. We present a novel injectable thermo-sensitive hydrogel system, KAF@PLEL, designed to deliver an anti-inflammatory peptide (KAF) specifically to the DRG. This biodegradable hydrogel enables sustained KAF release, promoting the reprogramming of DRG macrophages from pro-inflammatory to anti-inflammatory phenotypes. Through comprehensive in vitro and in vivo studies, we evaluated the hydrogel's biocompatibility, effects on macrophage polarization, and therapeutic efficacy in chronic OA pain management. The system demonstrated significant capabilities in preserving macrophage mitochondrial function, suppressing neuroinflammation, alleviating chronic OA pain, reducing cartilage degradation, and improving motor function in OA rat models. The sustained-release properties of KAF@PLEL enabled prolonged therapeutic effects while minimizing systemic exposure and side effects. These findings suggest that KAF@PLEL represents a promising therapeutic approach for improving outcomes in OA patients through targeted, sustained treatment.

Objective:Reviewed the scope of the application of time-driven activity based costing(TDABC) in nursing costing, and the connotation of time-driven job costing, the current status of research, and the evaluation of the application effect were systematically sorted out. In order to provide an effective method for the improvement of nursing cost accounting level in China.Methods:In accordance with the scope review methodology of Arksey and O′Malley, the Cochrane Library, PubMed, Web of Science, Embase, Scopus, CINAHL, SinoMed, CNKI, Wanfang and VIP Database were systematically searched for relevant literature on the application of nursing costingrelated literature on time-driven job costing. The time frame was from the construction of the database to March 1, 2024. Summarization and analysis were conducted independently by 2 trained and qualified researchers, and third-party experts were invited to share decision-making in case of disagreement.Results:Twenty-seven literatures from nine countries were included. A review of the literature revealed that time-driven job costing is used throughout the entire process of nursing costing, and the results of its application include optimizing the allocation of nursing resources, accurately accounting for the true costs of clinical care pathways and processes, and assisting in the analysis of nursing cost decisions.Conclusions:TDABC has been widely recognized internationally, effectively supporting refined cost management and promoting decision-making optimisation. However, the current development of TDABC in nursing costing in China is yet to be perfected. In the future, we should deeply explore the combination of TDABC with the local healthcare system, and promote its wide application in China, so as to achieve the dual optimisation of cost control and nursing quality, and to better reflect the economic and social value of nursing services.

Objective:Reviewed the scope of the application of time-driven activity based costing(TDABC) in nursing costing, and the connotation of time-driven job costing, the current status of research, and the evaluation of the application effect were systematically sorted out. In order to provide an effective method for the improvement of nursing cost accounting level in China.Methods:In accordance with the scope review methodology of Arksey and O′Malley, the Cochrane Library, PubMed, Web of Science, Embase, Scopus, CINAHL, SinoMed, CNKI, Wanfang and VIP Database were systematically searched for relevant literature on the application of nursing costingrelated literature on time-driven job costing. The time frame was from the construction of the database to March 1, 2024. Summarization and analysis were conducted independently by 2 trained and qualified researchers, and third-party experts were invited to share decision-making in case of disagreement.Results:Twenty-seven literatures from nine countries were included. A review of the literature revealed that time-driven job costing is used throughout the entire process of nursing costing, and the results of its application include optimizing the allocation of nursing resources, accurately accounting for the true costs of clinical care pathways and processes, and assisting in the analysis of nursing cost decisions.Conclusions:TDABC has been widely recognized internationally, effectively supporting refined cost management and promoting decision-making optimisation. However, the current development of TDABC in nursing costing in China is yet to be perfected. In the future, we should deeply explore the combination of TDABC with the local healthcare system, and promote its wide application in China, so as to achieve the dual optimisation of cost control and nursing quality, and to better reflect the economic and social value of nursing services.

Objective:To analyze the gene mutation type and clinical phenotype of patients with PRRT2 mutation, and explore their relations with prognosis. Methods:A total of 18 patients with PRRT2 gene mutation (1 patient with novel mutation in PRRT2 gene, and 17 probands in 17 families with PRRT2 gene mutation) were enrolled in Department of Neurology, First Affiliated Hospital of Air Force Medical University from January 2018 to July 2023. Serum of the patients was collected for whole exon sequencing, and mutation sites and types of PRRT2 gene were analyzed. SWISS-MODEL website was used to predict the changes in protein structure caused by PRRT2 gene mutation. The relations of gene mutation type and clinical phenotype with prognosis of these patients were analyzed. Results:(1) All 18 patients with PRRT2 gene mutation were heterozygous mutation, including 12 frameshift mutations, 5 missense mutations, and 1 integer mutation. The clinical phenotype included benign familial infantile epilepsy (BFIE) in 5 patients, epilepsy in 6 patients, exercise-induced paroxysmal kinesigenic dyskinesia (PKD) in 5 patients, and infantile convulsion and choreoathetosis (ICCA) in 2 patients. A total of 8 mutation sites were found in 18 patients with PRRT2 gene mutation, of which 3 mutation sites have been reported, and 5 mutation sites have not been reported, including c.647(exon2)C>A, c.647(exon2)C>G, c.170(exon2)delC, c.981(exon3)C>G, and lossl(EXON: 2)(all). (2) Eighteen patients mainly accepted oxcarbazepine, levetiracetam, and sodium valproate in combination or monotherapy. Among them, 5 BFIE patients, 2 ICCA patients and 3 epilepsy patients were seizure-free after treatment. PKD patients did not respond well to oxcarbazepine. (3) Three frameshift mutations (mutation sites: c.649 [exon2]_c.650 [exon2] insC, c.640 [exon2]_c.641 [exon2] insC, and c.170 [exon2] delC) led to premature termination of protein translation, resulting in significant changes in protein structure. Four missense mutations (mutation sites: c.640[exo2]G>C, c.647[exon2]C>A, c.647[exon2]C>G, and c.981[exon3]C>G) had little effect on protein structure changes. No relation was found between changes of protein structure caused by different mutation types and prognosis. Conclusion:PRRT2 gene mutation patients with clinical phenotypes of BFIE and ICCA have good prognosis, but the mutation type is not related with the prognosis of patients.

Objective:To understand the current status of financial toxicity in patients with heart failure and the factors affecting it, and to provide ideas for making personalized and informed decisions.Methods:Using a scoping review methodological framework, PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, VIP, Wanfang, and SinoMed Databases were searched and screened for relevant literature on financial toxicity in patients with heart failure, with a timeframe of January 1, 2014-October 31, 2023, respectively. Relevant literature was identified based on inclusion and exclusion criteria, and data were extracted, collected, summarized, and the findings were reported.Results:Ten literatures that met the inclusion and exclusion criteria were identified. The results showed 5 cross-sectional surveys, 2 qualitative studies, and 1 each of reviews, mixed studies and commentaries. Heart failure patients generally faced high levels of financial toxicity, the incidence and severity of patient financial toxicity varied somewhat between study outcomes. Factors influencing financial toxicity in heart failure patients included age, education level, family income level, discussion of medical costs with physicians, type of insurance the patient had, and occupational status.Conclusions:In the future, we can develop and apply a specialized assessment tool for financial toxicity in heart failure patients in China, further explore the factors affecting financial toxicity in heart failure patients, and formulate personalized treatment plans and financial support strategies for patients according to the influencing factors, so as to reduce the impact of financial toxicity on heart failure patients.

Objective To investigate the therapeutic effects of Isaria felina derived from Cordyceps sinensis combined with cyclophosphamide(CTX)in hepatoma H22 tumor-bearing mice.Methods An H22 tumor-bearing mouse model was established and mice were divided randomly into a normal control group(NC group,distilled water),model control group(MC group,distilled water),positive control group(CTX group,25 mg/kg),Isaria felina group(IF group,400 mg/kg),and combined administration group(IF+CTX group,IF 400 mg/kg+CTX 25 mg/kg),with 5 mice in each group.Distilled water and IF were administered by gavage,and CTX was administered by intraperitoneal injection.The administration cycle was 10 days.At the end of the experiment,the mean tumor volume and weight,tumor inhibition rate,q value,and immune organ index were calculated,and routine blood indexes and cytokine levels were determined.Histopathological changes in tumor tissues were observed by HE staining.Results The tumor volume and mass were significantly lower in mice in each treatment group compared with those in mice in the MC group(P＜0.05).The tumor inhibition rates in the CTX,IF,and IF+CTX groups were 49.3%,34.2%,and 72.8%,respectively,and the q value was 1.09.The numbers of white blood cells,Lymph,and platelets were significantly higher in the IF+CTX group than in the CTX group(P＜0.05).The spleen index was significantly higher in the MC group compared with that in the NC group,and significantly lower in the IF+CTX group compared with that in the MC group(P＜0.05).Serum interferon-γ levels were significantly lower in the MC group than in the NC group,and were significantly higher in the IF and IF+CTX groups compared with those in the MC and CTX groups(P＜0.05).Pathologically,tumor cells in the MC group grew well and were numerous and closely arranged,while cells in the CTX,IF,and IF+CTX groups were arranged loosely,with focal necrosis and nuclear pyknosis of necrotic cells in many places.Conclusions The combination of IF and CTX has an additive anti-tumor effect on H22 tumor-bearing mice,which can alleviate immunosuppression and have an immunomodulatory function.

Objective To investigate the prognostic value of serum bispecific phosphatase 1(DUSP1)ex-pression level in patients with acute pulmonary thromboembolism(APTE).Methods A total of 112 patients with APTE admitted to the hospital from March 2020 to July 2022 were enrolled as the observation group,and 50 healthy individuals who underwent physical examinations in the hospital during the same period were en-rolled as the control group.The APTE patients were followed up for 6 months after treatment,and were grouped into a good prognosis group(90 cases)and a poor prognosis group(22 cases)based on their progno-sis.The serum DUSP1 relative expression level and pulmonary embolism severity index(PESI)score were compared among the groups before admission.Spearman correlation was applied to analyze the relationship between serum DUSP1 relative expression level and PESI score.Receiver operating characteristic(ROC)curve was applied to analyze the predictive value of serum DUSP1 relative expression level and PESI score on the prognosis of APTE patients.Results Compared with the control group,the serum DUSP1 relative expres-sion level in the observation group was increased(P<0.05).There were statistically significant differences in serum DUSP1 relative expression level and PESI score among patients with different risk levels(P<0.05),the serum DUSP1 relative expression level and PESI score in high-risk APTE patients were higher than those in medium-risk patients(P<0.05),and those in medium-risk patients were higher than those in low-risk pa-tients(P<0.05).Spearman correlation analysis showed that serum DUSP1 relative expression level was posi-tively correlated with PESI score(r=0.561,P<0.05).ROC curve results showed that the area under the curve(AUC)of DUSP1 and PESI score alone for predicting the poor prognosis in APTE patients was 0.789 and 0.867,with sensitivity of 65.8%and 86.8%,specificity of 44.2%and 67.2%,respectively.The AUC of the combination of the two for predicting the poor prognosis in APTE patients was 0.952,with sensitivity and specificity of 92.1%and 75.6%,respectively.Conclusion The serum DUSP1 relative expression level in APTE patients is elevated,and with the aggravation of the disease,the serum DUSP1 relative expression level gradually increases.DUSP1 is an effective indicator for predicting poor prognosis in APTE patients.

Objective:To treat the Crohn's disease(CD)patients with ustekinumab(UST),to eva-luate their clinical and endoscopic remission,and to evaluate their transmural response(TR)and trans-mural healing(TH)condition using intestinal ultrasonography(IUS).Methods:Retrospective analysis was made on patients diagnosed with CD in Peking University People's Hospital from January 2020 to Au-gust 2022,who were treated with UST for remission induction and maintenance therapy.All the patients were evaluated on both week 8 and week 16/20 after treatment,including clinical,biochemical indica-tors,colonoscopy and IUS examination.Results:A total of 13 patients were enrolled in this study,inclu-ding 11 males and 2 females.The minimum age was 23 years,the maximum age was 73 years and the mean age was 36.92 years.All the patients were in the active stage of disease before treatment,and the average Best Crohn's disease activity index(Best CDAI)score was 270.12±105.55.In week 8,the Best CDAI score of the patients decreased from 270.12±105.55 to 133.16±48.66(t=4.977,P＜0.001).Eight patients achieved clinical remission while 5 patients remained in the active stage.Nine patients underwent colonoscopy evaluation.The average simple endoscopic score for Crohn's disease(SES-CD)score decreased from 10.71±7.14 before treatment to 6.00±7.81(t=2.483,P=0.048)in week 16/20.Four patients achieved endoscopic remission while 5 patients did not.In week 8,5 pa-tients achieved TR,2 patients achieved TH,the other 6 patients did not get TR or TH.In week 16/20,6 patients achieved TR,3 patients achieved TH while the other 4 patients did not get TR or TH.There was no significant statistical difference in the TR effect of UST between small intestine and colon lesions(Fisher test,P＞0.999).The rate of UST transmural response in the patients who had had previous bio-logical agent therapy was lower than those with no previous biological agent therapy,but there was no sig-nificant statistical difference(Fisher test,P=0.491).Conclusion:After treatment of UST,the clinical and endoscopic conditions of the CD patients had been improved,and some patients could achieve clini-cal remission and endoscopic remission.UST had good TR and TH effects on CD.TR might appear in week 8,and the TR effect increased in week 16/20.There was no significant statistical difference in the TR effect between small intestine and colon lesions.TR effect of UST was better in the patients who had no previous biological agent therapy than those who had had other biological agents,but the result had no significant statistical difference.