Acute pancreatitis(AP)is a frequently encountered acute abdominal syndrome in clinical settings,and the integrated model of traditional Chinese and Western medicine(TCM-WM)has demonstrated notable advantages in the diagnosis and treatment of AP.To systematize and standardize clinical practices related to develop clinical pathway for integrated TCM-WM diagnosis and treatment of AP,which enhances the efficiency and quality of patient care.This pathway focuses on AP,a common acute and life-threatening disease within the digestive system,and outlines that the central pathological mechanism involves pancreatic injury and localized inflammation resulting from the abnormal activation of pancreatic enzymes.It has the characteristics of rapid onset,multiple causes,and complex manifestations.Severe cases can be life-threatening.At present,conventional treatments encompass a diverse range of modalities.Moreover,traditional Chinese medicine(TCM)holds distinct advantages in alleviating relevant symptoms,and TCM-WM is gaining increasing prevalence.To enhance the standardization and consistency of diagnostic and therapeutic practices,this clinical pathway clearly delineates the target patient population,which includes individuals diagnosed with abdominal pain disorder according to TCM and with AP in accordance with WM criteria,as well as the corresponding inclusion standards.The diagnostic framework integrates both TCM and WM guidelines,and further incorporates disease staging,severity grading,and syndrome differentiation to support a comprehensive and integrated diagnostic strategy.The treatment integrates approaches from both TCM and WM.Within the WM framework,interventions consist of basic supportive care,infection control,nutritional support,and the management of complications.In the context of TCM,the protocol includes syndrome differentiation and corresponding therapeutic strategies(Distinct syndrome patterns are identified and managed during the acute and convalescent phases),such as acupuncture and retention enema.This clinical pathway addresses multiple key components,including preventive strategies,post-treatment follow-up,criteria for evaluating therapeutic efficacy,admission and discharge,admission examination protocols,discharge criteria,and the rationale for deviations or withdrawal from the pathway.It is designed to provide a systematic and standardized reference framework for relevant clinical practices.

To provide scientific guidance and standardization for perioperative clinical nursing practice in patients undergoing percutaneous renal biopsy, relevant evidence on percutaneous renal biopsy nursing care was systematically retrieved and synthesized through an evidence-based approach. After two rounds of Delphi expert consultation and expert panel discussions, expert consensus on perioperative clinical nursing standards for patients undergoing percutaneous renal biopsy (hereinafter referred to as the "Consensus") was developed. The Consensus includes three primary themes: preoperative care, intraoperative care, and postoperative care, encompassing 21 secondary themes. It is characterized by scientific rigor, practical applicability, and comprehensiveness, and serves as a valuable reference and guide for clinical nursing professionals across medical institutions.

Objective:To identify different subtypes of patients with preeclampsia(PE)through clinical liver function index data-driven the cluster analysis,to explore the correlation between liver function of different sub-types and pregnancy complications.Methods:From January 2012 to December 2022,the general data of 2230 sin-gleton pregnant women with PE who underwent prenatal examination and delivered in Fujian Maternity and Child Health Hospital were collected.Using 13 liver function indexes before delivery as baseline variables,all included subjects were classified into subtypes by cluster method.The clinical characteristics of different subtypes of PE patients were compared.Single-factor Logistic regression was used to analyze the risk of pregnancy complications among subtypes.Results:PE patients were divided into 3 subgroups that represented different characteristics of patients' liver function.The first subtype(n=1065)exhibited abnormal liver enzymology index characterized by in-creased alkaline phosphatase(ALP)level.The second subtype(n=648)showed abnormal bilirubin metabolism index with the highest levels of total bilirubin(TBIL),direct(DBIL)and indirect bilirubin(IBIL).The third subtype(n=517)had abnormal liver enzymology indexes with elevated alanine aminotransferase(ALT)and aspartate aminotransferase(AST)levels,abnormal bile acid detection indexes with elevated total bile acid(TBA)levels,and abnormal liver synthesis function indexes with decreased total protein(TP),albumin(ALB),and globulin lev-els(GLB).Significant differences were observed among the three subtypes in age,severe PE,anemia,cardiac dysfunction,and renal dysfunction(P＜0.05).Single-factor Logistic regression demonstrated that the third sub-type had significantly higher risks of intrahepatic cholestasis of pregnancy,fetal growth restriction,premature rup-ture of membranes,and preterm birth compared to the first and second subtypes(P＜0.05),as well as a higher risk of placental abruption than the second subtype(P＜0.05).The first subtype had higher risks of placental ab-ruption and fetal growth restriction than the second subtype(P＜0.05).Conclusions:Cluster analysis could be used to subclassify PE patients by liver function characteristics,so as to identify the occurrence of pregnancy complications.The results had significance for understanding the heterogeneity of PE and promoting individualized management.

Objective:To identify different subtypes of patients with preeclampsia(PE)through clinical liver function index data-driven the cluster analysis,to explore the correlation between liver function of different sub-types and pregnancy complications.Methods:From January 2012 to December 2022,the general data of 2230 sin-gleton pregnant women with PE who underwent prenatal examination and delivered in Fujian Maternity and Child Health Hospital were collected.Using 13 liver function indexes before delivery as baseline variables,all included subjects were classified into subtypes by cluster method.The clinical characteristics of different subtypes of PE patients were compared.Single-factor Logistic regression was used to analyze the risk of pregnancy complications among subtypes.Results:PE patients were divided into 3 subgroups that represented different characteristics of patients' liver function.The first subtype(n=1065)exhibited abnormal liver enzymology index characterized by in-creased alkaline phosphatase(ALP)level.The second subtype(n=648)showed abnormal bilirubin metabolism index with the highest levels of total bilirubin(TBIL),direct(DBIL)and indirect bilirubin(IBIL).The third subtype(n=517)had abnormal liver enzymology indexes with elevated alanine aminotransferase(ALT)and aspartate aminotransferase(AST)levels,abnormal bile acid detection indexes with elevated total bile acid(TBA)levels,and abnormal liver synthesis function indexes with decreased total protein(TP),albumin(ALB),and globulin lev-els(GLB).Significant differences were observed among the three subtypes in age,severe PE,anemia,cardiac dysfunction,and renal dysfunction(P＜0.05).Single-factor Logistic regression demonstrated that the third sub-type had significantly higher risks of intrahepatic cholestasis of pregnancy,fetal growth restriction,premature rup-ture of membranes,and preterm birth compared to the first and second subtypes(P＜0.05),as well as a higher risk of placental abruption than the second subtype(P＜0.05).The first subtype had higher risks of placental ab-ruption and fetal growth restriction than the second subtype(P＜0.05).Conclusions:Cluster analysis could be used to subclassify PE patients by liver function characteristics,so as to identify the occurrence of pregnancy complications.The results had significance for understanding the heterogeneity of PE and promoting individualized management.

Acute pancreatitis(AP)is a frequently encountered acute abdominal syndrome in clinical settings,and the integrated model of traditional Chinese and Western medicine(TCM-WM)has demonstrated notable advantages in the diagnosis and treatment of AP.To systematize and standardize clinical practices related to develop clinical pathway for integrated TCM-WM diagnosis and treatment of AP,which enhances the efficiency and quality of patient care.This pathway focuses on AP,a common acute and life-threatening disease within the digestive system,and outlines that the central pathological mechanism involves pancreatic injury and localized inflammation resulting from the abnormal activation of pancreatic enzymes.It has the characteristics of rapid onset,multiple causes,and complex manifestations.Severe cases can be life-threatening.At present,conventional treatments encompass a diverse range of modalities.Moreover,traditional Chinese medicine(TCM)holds distinct advantages in alleviating relevant symptoms,and TCM-WM is gaining increasing prevalence.To enhance the standardization and consistency of diagnostic and therapeutic practices,this clinical pathway clearly delineates the target patient population,which includes individuals diagnosed with abdominal pain disorder according to TCM and with AP in accordance with WM criteria,as well as the corresponding inclusion standards.The diagnostic framework integrates both TCM and WM guidelines,and further incorporates disease staging,severity grading,and syndrome differentiation to support a comprehensive and integrated diagnostic strategy.The treatment integrates approaches from both TCM and WM.Within the WM framework,interventions consist of basic supportive care,infection control,nutritional support,and the management of complications.In the context of TCM,the protocol includes syndrome differentiation and corresponding therapeutic strategies(Distinct syndrome patterns are identified and managed during the acute and convalescent phases),such as acupuncture and retention enema.This clinical pathway addresses multiple key components,including preventive strategies,post-treatment follow-up,criteria for evaluating therapeutic efficacy,admission and discharge,admission examination protocols,discharge criteria,and the rationale for deviations or withdrawal from the pathway.It is designed to provide a systematic and standardized reference framework for relevant clinical practices.

To provide scientific guidance and standardization for perioperative clinical nursing practice in patients undergoing percutaneous renal biopsy, relevant evidence on percutaneous renal biopsy nursing care was systematically retrieved and synthesized through an evidence-based approach. After two rounds of Delphi expert consultation and expert panel discussions, expert consensus on perioperative clinical nursing standards for patients undergoing percutaneous renal biopsy (hereinafter referred to as the "Consensus") was developed. The Consensus includes three primary themes: preoperative care, intraoperative care, and postoperative care, encompassing 21 secondary themes. It is characterized by scientific rigor, practical applicability, and comprehensiveness, and serves as a valuable reference and guide for clinical nursing professionals across medical institutions.

High glucose level, bacterial infection, and persistent inflammation within the microenvironment are key factors contributing to the delay of diabetic ulcers healing, while traditional therapeutic methods generally fail to address these issues simultaneously. Here, we present a spatiotemporally responsive cascade bilayer microneedle (MN) patch for accelerating diabetic wound healing via local glucose depletion and sustained nitric oxide (NO) release for long-term antibacterial and anti-inflammatory effects. The MN patch (G/AZ-MNs) possesses a degradable tip layer loading glucose oxidase (GOx), as well as a dissolvable base layer encapsulating l-arginine (Arg)-loaded nanoparticles (NPs). After wound administration, the base part rapidly dissolved, resulting in prompt separation of the MN tip within the wound tissue, which subsequently responded to the overexpressed matrix metalloproteinase-9 (MMP-9) in diabetic lesions, leading to the responsive release of GOx. The released enzyme catalyzed glucose into gluconic acid and hydrogen peroxide (H₂O₂), which not only reduced glucose level within the diabetic wound, but also initiated the cascade reaction between H₂O₂ with the Arg that was released from NPs, thereby achieving continuous production of NO for 7 days. Our findings demonstrate that a single administration of the MN patch could effectively heal non-infected or biofilm-infected diabetic wounds with the multifunctional properties.

Objective:To explore the effect of nirmatrelvir/ritonavir (Paxlovid) on renal function in patients with coronavirus disease 2019 (COVID-19) and renal insufficiency.Methods:Clinical data of renal insufficiency patients with COVID-19, who were hospitalized at Beijing Ditan Hospital, Capital Medical University from March 23, 2022 to April 30, 2023 and received Paxlovid treatment, were collected. A retrospective analysis was conducted on the incidence of Paxlovid-related acute kidney injury (AKI) and changes of blood urea, serum creatinine (Scr), blood uric acid, and estimated glomerular filtration rate (eGFR) in patients before and after Paxlovid treatment.Results:A total of 386 patients were included in the analysis, including 220 males (57.0%) and 166 females (43.0%), with a median age of 79 years. COVID-19 was classified as asymptomatic in 42 patients (10.9%), mild in 175 patients (45.4%), moderate in 126 patients (32.6%), severe in 34 patients (8.8%), and critical in 9 patients (2.3%). The renal insufficiency was mild in 246 patients (63.7%), moderate in 110 patients (28.5%), and severe in 30 patients (7.8%). Among 386 patients, 16 (4.1%) developed AKI during Paxlovid treatment or within 48 hours after withdrawal, 5 (1.3%) of which were judged to be related to Paxlovid. The 5 patients aged 70 years and above, and all used nephrotoxic drugs. After Paxlovid treatment, the blood urea, Scr, blood uric acid, and eGFR in the 386 patients were all improved compared to before, and the differences were statistically significant [Scr: (133.8±9.3) μmol/L vs. (111.7±6.6) μmol/L; blood uric acid: (335.9±7.1) μmol/L vs. (291.9±5.8) μmol/L; eGFR: (63.4±1.1) ml/(min·1.73 m 2) vs. (69.1±1.2) ml/(min·1.73 m 2); all P<0.05]. Conclusions:The overall safety of Paxlovid treatment for COVID-19 in patients with renal insufficiency is good, and it has no significant impact on the renal function in the vast majority of patients. However, for elderly people aged 70 years and above, especially for those who have combination medications of nephrotoxic drugs, the occurrence of AKI should still be vigilant.

Objective:To explore the effect of nirmatrelvir/ritonavir (Paxlovid) on renal function in patients with coronavirus disease 2019 (COVID-19) and renal insufficiency.Methods:Clinical data of renal insufficiency patients with COVID-19, who were hospitalized at Beijing Ditan Hospital, Capital Medical University from March 23, 2022 to April 30, 2023 and received Paxlovid treatment, were collected. A retrospective analysis was conducted on the incidence of Paxlovid-related acute kidney injury (AKI) and changes of blood urea, serum creatinine (Scr), blood uric acid, and estimated glomerular filtration rate (eGFR) in patients before and after Paxlovid treatment.Results:A total of 386 patients were included in the analysis, including 220 males (57.0%) and 166 females (43.0%), with a median age of 79 years. COVID-19 was classified as asymptomatic in 42 patients (10.9%), mild in 175 patients (45.4%), moderate in 126 patients (32.6%), severe in 34 patients (8.8%), and critical in 9 patients (2.3%). The renal insufficiency was mild in 246 patients (63.7%), moderate in 110 patients (28.5%), and severe in 30 patients (7.8%). Among 386 patients, 16 (4.1%) developed AKI during Paxlovid treatment or within 48 hours after withdrawal, 5 (1.3%) of which were judged to be related to Paxlovid. The 5 patients aged 70 years and above, and all used nephrotoxic drugs. After Paxlovid treatment, the blood urea, Scr, blood uric acid, and eGFR in the 386 patients were all improved compared to before, and the differences were statistically significant [Scr: (133.8±9.3) μmol/L vs. (111.7±6.6) μmol/L; blood uric acid: (335.9±7.1) μmol/L vs. (291.9±5.8) μmol/L; eGFR: (63.4±1.1) ml/(min·1.73 m 2) vs. (69.1±1.2) ml/(min·1.73 m 2); all P<0.05]. Conclusions:The overall safety of Paxlovid treatment for COVID-19 in patients with renal insufficiency is good, and it has no significant impact on the renal function in the vast majority of patients. However, for elderly people aged 70 years and above, especially for those who have combination medications of nephrotoxic drugs, the occurrence of AKI should still be vigilant.

Objective:To investigate the status quo of stress response, self-care and job performance among nurses in emergency department, and to analyze whether self-care has a mediating effect between stress response and job performance.Methods:This was a cross-sectional survey. From February to April 2022, 467 emergency department nurses from 11 tertiary hospitals in Changsha were investigated and analyzed by using random cluster sampling method, general data questionnaire, Stress Response Questionnaire, Self-Compassion Scale and Nursing Performance Scale.Results:The total score of nurses′ Stress Response Questionnaire was (78.02 ± 26.78) points, the total score of Self-Compassion Scale was (81.75 ± 22.23) points, and the total score of Nursing Performance Scale was (74.05 ± 21.57) points. Stress response was negatively correlated with self-care and work performance ( r=-0.452, -0.572, both P<0.01), and self-care was positively correlated with work performance ( r=0.515, P<0.01). Self-care played a partial mediating role between stress response and job performance, accounting for 26.98% of the total effect. Conclusions:Self-care is an intermediary variable between emergency department nurses′ stress response and work performance. Nursing managers should pay attention to emergency department nurses′self-care and stress response levels, and evaluate them regularly in order to take timely intervention measures to improve their self care ability, reduce stress response, and improve work performance of emergency department nurses.