Objective To assess the nutritional status in elderly patients with chronic renal insufficiency (CRI) and reveal the key factors affecting the nutritional status. Methods A total of 310 elderly patients with CRI who received hospitalization treatment and outpatient follow-up in the hospital from January 2021 to June 2024 were selected as the investigation subjects. The nutritional status of patients was evaluated by mini-nutritional assessment (MNA) questionnaire, and the nutritional status and dietary structure of patients were comprehensively evaluated by anthropometric indicators [height, weight, body mass index (BMI), upper arm circumference, calf circumference], biochemical indicators [serum albumin (ALB), prealbumin (PA), hemoglobin (Hb), transferrin (TF)] and 24-hour dietary review method. According to the investigation results of nutritional status, the patients were divided into good nutrition group (MNA score≥24 points), nutritional risk group (MNA score of 17-23.5 points) and malnutrition group (MNA score<17 points). Univariate analysis was adopted to screen the potential influencing factors of elderly CRI. Multivariate logistic regression model was applied to analyze the influencing factors of malnutrition in elderly CRI patients. Results Among the 325 questionnaires were distributed, but only 310 valid questionnaires were recovered, with an effective recovery rate of 95.38%. Investigation results revealed that among the 310 patients, 29.35% (91 cases) had good nutritional status, and 42.26% (131 cases) had nutritional risk, and 28.39% (88 cases) had malnutrition. Univariate analysis indicated that there were statistical differences in BMI, CRI staging, serum ALB, PA, Hb, TF, protein intake and total calorie intake among the good nutrition group, the nutritional risk group and the malnutrition group (P<0.05). Multivariate logistic regression analysis suggested that low BMI (OR=0.903, 95%CI: 0.867-0.941), high CRI stage (OR=1.091, 95%CI: 1.053-1.130), low serum ALB (OR=0.907, 95%CI: 0.867-0.948), PA (OR=0.918, 95%CI: 0.888-0.949), Hb (OR=0.944, 95%CI: 0.909-0.997), TF (OR=0.912, 95%CI: 0.874-0.952), insufficient protein intake (OR=0.924, 95%CI: 0.882-0.969) and insufficient total calorie intake (OR=0.938, 95%CI: 0.909-0.968) were influencing factors for malnutrition in elderly patients with CRI (all P<0.05). Drawing ROC curve of malnutrition in elderly patients with CRI according to the prediction probability of logistic regression model found that the AUC, sensitivity, specificity, 95%CI and Youden index were 0.976, 93.18%, 92.34%, 0.953-0.990 (P<0.05) and 0.855. Conclusion The incidence rate of malnutrition is high in elderly patients with CRI, and is mainly affected by factors such as low BMI, high CRI stage, low serum ALB, PA, Hb and TF levels and insufficient protein and total calorie intakes. In addition, logistic regression model has high predictive value and can provide a reference for early clinical identification of high-risk population with malnutrition among elderly patients with CRI.

Objective:To observe the application value of "Internet +" based case teaching method combined with objective structured clinical examination (OSCE) teaching method in the teaching of nursing students in the Department of Nephrology, and analyze its impact on nursing student satisfaction of teaching.Methods:A total of 60 nursing students who practiced in the Department of Nephrology, Jiangsu Provincial People's Hospital from January 2021 to June 2022 were selected as the research subjects. They were randomly divided into observation group and control group, with 30 students in each group. The control group adopted traditional teaching method, and the observation group adopted case teaching method based on "Internet +" combined with OSCE teaching method. SPSS 25.0 statistical software was used for data analysis, and independent sample t-test was used to compare the clinical practical work ability and teaching satisfaction of the two groups of nursing students after teaching. Results:After 4 weeks of teaching, the total scores of clinical thinking ability, disease observation and evaluation ability, mastery of medical knowledge, standardized operation ability, communicative ability, adaptive ability, humanistic care and health literacy of the observation group were higher than those of the control group [(29.84±3.52) vs. (25.67±3.36), (5.81±1.52) vs. (4.34±1.67), (17.93±2.24) vs. (15.52±2.05), (25.72±2.73) vs. (22.17±2.56), (4.18±0.75) vs. (3.56±0.69), (83.48±6.67) vs. (71.26±7.05)], with a statistically significant difference ( P < 0.05); after 4 weeks of teaching, the teaching preparation, teaching process, teaching ability, teaching attitude, teaching effect and total score of the observation group were higher than those of the control group [(17.13±2.42) vs. (15.07±1.84), (36.44±3.12) vs. (34.07±2.49), (21.97±2.36) vs. (21.37±2.01),(17.00±2.36) vs. (16.83±2.23), (17.73±2.00) vs. (14.07±2.55), (110.27±5.51) vs. (101.40±4.58)], and the difference was statistically significant ( P<0.05). Conclusions:The case teaching method based on "Internet +" combined with OSCE can not only effectively improve the clinical practical work ability of nursing students in the department of nephrology, but also improve student satisfaction of teaching.

Long non-coding RNAs (lncRNAs) are aberrantly expressed in keloids, and some lncRNAs can interact with miRNAs and act as competitive endogenous RNAs (ceRNAs) to regulate downstream mRNA expression. These RNA molecules are interconnected to form a complex ceRNA regulatory network, playing an important role in the occurrence and development of keloids. This review summarizes the relationship of lncRNAs and their mediated ceRNA regulatory networks with keloids, in order to further explore the pathogenesis of keloids.

Objective:To construct a virtual simulation training platform for peripheral inserted central catheter (PICC) catheterization and discuss its application in clinical training.Methods:A total of 118 nurses who attended the PICC professional and technical advanced training courses in a province in 2020 and 2021 were enrolled in this study. In 2020, the training was conducted in the form of theoretical teaching combined with practical training ( n=51), and in 2021, virtual simulation platform was introduced as a supplement on the basis of the original training ( n=67). SPSS 23.0 was used for independent-samples t-test to compare the theoretical and operational assessment results of the two years and evaluate the application effect of the platform. Through the satisfaction survey and learning log, the nurses' experience of using the platform was understood. Results:The theoretical performance and the operational performance of nurses who participated in the training in 2021 were (96.56±3.17) and (94.06±2.16) respectively, and the operational performance was better than that of nurses who participated in the training in 2020 ( t=-11.37, P<0.001), and the difference in theoretical performance was not statistically significant ( t=0.17, P=0.853). In 2021, 63 nurses (94.0%) who used the virtual simulation platform believed that the platform could assist to improve the training effect; 61 nurses (91.0%) expected the application of virtual simulation technology in the teaching and training of other knowledges. Conclusion:As a new teaching form, virtual simulation technology can significantly improve the training effect and satisfaction, and provide reference for the development of relevant teaching and training.

Objective:To analyze the association between exposure to ambient PM 2.5 and its components [sulfate (SO 42-), nitrate (NO 3-), ammonium (NH 4+), organic matter (OM), and black carbon (BC)] and psychological distress among school children and adolescents aged 9 to 18 years in China. Methods:Based on data from the 2019 Chinese National Survey on Students' Constitution and Health, 130 808 children and adolescents aged 9 to 18 years were included. Scoring and determination of higher psychological distress were based on the Kessler Psychological Distress Scale (K10), and annual average exposure data for air pollution were matched by survey location and time. We used a restricted cubic spline approach based on logistic regression to fit the associations between PM 2.5, SO 42-, NO 3-, NH 4+, organic matter, black carbon concentrations, and psychological distress. Logistic regression models were used to analyse different age, gender, BMI and physical activity subgroups to estimate the association between exposure to high levels of pollution and high levels of psychological distress in different subgroups. Results:The proportion of children and adolescents with high levels of psychological distress in China was 30.4%, with girls being higher than boys at 31.6% and 29.1%, respectively ( P<0.05). A non-linear positive association existed between exposure to PM 2.5, SO 42-, NO 3- and organic matter concentrations and higher psychological distress. As PM 2.5, NO 3-, NH 4+, organic matter, and black carbon concentrations continued to rise, the increase in the risk of higher psychological distress slowed, while SO 42- showed little change in the OR of psychological distress at lower concentrations but continued to rise at higher concentrations. PM 2.5 and its components were statistically associated with psychological distress in the physically inactive group but not in the physically active group. The association between high levels of pollutants and high psychological distress was stronger among students aged 9 to 12 years compared with students aged 13 to 15 years and 16 to 18 years. Conclusions:The ambient pollutant PM 2.5 and its components are associated with psychological distress in children and adolescents aged 9 to 18 years in China. High pollutant exposure is a risk factor for high psychological distress among physically inactive children and adolescents, and there are age differences in the association between PM 2.5 and components and psychological distress.

Post-intensive care syndrome (PICS) is the most common complication in patients discharged from intensive care unit (ICU), which seriously affects the life quality of the patients. At present, there is still lack of standardevaluation methods for PICS. Continuous and dynamic assessment can earlyidentify PICS, moreover, early identification and intervention of PICS can improve the life quality of patients those patients, which is critical to improve the long-term outcome of the patients. In this paper, we reviewed the current research states of evaluation timing, contents, tools and modalities of PICS domestic and abroad, analyzed the problems and prospects of the existing evaluation methods, aiming to provide a reference for clinical staff to effectively and comprehensively evaluate PICS.

Objective To test the clinical validity of use of the Chinese version of Munro adult pressure ulcer risk-assessment scales (Munro scales),Braden scales,Qian Weiming operation pressure ulcer risk-assessment scales (self-designed scales) in the patients with general anesthesia surgery.Methods Three investigators respectively used the Munro scales,Braden scales and self-designed scales to conduct the pressure ulcer risk-assessment on 261 patients with general anesthesia surgery before operation,at the end of operation and at exiting from anesthesia recovery room.The sensitivity,specificity,positive predictive value and negative predictive value of each assessment tool were calculated.Results The best critical values of the Munro scales before operation,at the end of operation and at exiting from anesthesia recovery room were 8.0,24.5,28.5 points respectively;which of the Braden scale were 18.5,11.5,13.5 points respectively;which of self-made scale were 12.5,13.5,13.5 points respectively.The area under the ROC curve of the three different scales at the beginning of the operation above was 0.653,0.596,0.652.The area under the ROC curve of the three different scales at the end of the operation above was 0.872,0.548,0.792.The areas under the ROC curve of the three different scales before operation were 0.868,0.773 and 0.813 respectively.Conclusion The Chinese version of Munro scales is more suitable for the assessment of operative patient's pressure ulcer risk than the Braden scale and self-designed scales,but the preoperative risk assessment needs to be improved.

Objective To investigate of the status quo of head nurses' professional practice environment and job burnout in classⅢ hospitals, and to discuss the influence of professional practice environment on job burnout. Methods From June to July 2016, a total of 335 head nurses from classⅢ hospitals of Hu'nan province were selected by cluster sampling method. All the participants were investigated by the Chinese version of Professional Practice Environment Scale for Head Nurses and Maslach Burnout Inventory. SPSS 18.0 software was applied to establish a database and to carry out statistical analysis. The influencing factors were analyzed by single factor analysis of variance and linear regression analysis. Results A total of 335 questionnaires were distributed, including 331 valid questionnaires. The total score of 331 head nurses professional practice environment score was (214.72±22.64). In the Maslach Burnout Inventory, the emotional exhaustion (EE) score was (26.02±11.03), depersonalization (DP) score was (9.31±4.30) and personal accomplishment (PA) was (34.66±12.98). Single factor analysis showed that the differences of EE score and DP score in head nurses in different age stages were statistically significant (F=6.429, 4.652; P<0.01). There was statistical significance in the difference of EE score of head nurses in different marital status (F=3.787, P< 0.05). There were statistical significance in the differences of EE score and DP score of head nurses with different nursing management years (F=2.448, 2.670;P<0.05). The differences of EE score in head nurses in different departments,the highest education and the professional titles were statistically significant (F=3.951,3.047,3.256;P< 0.05). The results of linear regression analysis showed that the 4 dimensions of cultural heritage, organization culture construction, relationship with doctors and relationship with nurses were the key variables influencing job burnout scores. Conclusions The status quo of professional practice environment is not optimistic, the tendency of job burnout is obvious, and the professional practice environment has an impact on the job burnout of head nurses.

Objective To explore the status quo and the correlation of professional practice environment and job burnout in head nurses. Methods Totally 646 head nurses from city state hospitals of Hunan Province was selected by cluster sampling method. Participants were investigated by using the Chinese Version of Profession Practice Environment Scale for Head Nurses and Maslach Burnout Inventory. Results The professional environment score was 215.95±22.81, which was in the moderate level. The score of emotional exhaustion (EE) in head nurses was 24.56 ± 10.64, depersonalization (DP) was 8.92 ± 4.17 and personal accomplishment (PA) was 35.55±13.08, all stating moderate burnout. Meanwhile, the scores of EE and DP were negatively correlated with professional practice environment (r=-0.350--0.161, P≤0.01), while the PA was positively correlated with professional practice environment (r=0.078- 0.271, P≤0.01). Conclusions Professional practice environment in head nurses is correlated with job burnout. Hospital leaders should pay more attention to head nurses′professional practice environment to decrease job burnout in head nurses.

302 teeth with wedge-shaped defect in 168 patients were restored by SDR(smart dentin replacement,n =112),glass ionomer (n =98) and light-cured composite resin(n =92) respectively.12 to 15 month follow-up showed the success rate was 96.2％,84.8％ and 86.2％ respectively(P ＜ 0.01).SDR is an ideal material in restoring wedge-shaped defect.