Objective To analyze the current status and influencing factors of occupational burnout among medical staff in Dongguan City. Methods A total of 1 007 medical staff from eight hospitals in Dongguan City were selected as the study subjects using the stratified sampling method. The Maslach Burnout Inventory-Human Service Survey and Moral Injury Symptom Scale (Healthcare Professionals Edition) were used to assess occupational burnout and moral injury among these study subjects. Binary logistic regression analysis was conducted to identify the influencing factors of occupational burnout. Results The detection rate of occupational burnout among the medical staff was 46.2%, and the detection rate of moral injury was 48.1%. The result of binary logistic regression analysis showed that after controlling for confounding factors such as age, marriage status, educational level, religious belief, professional title, and hospital characteristics, male medical staff had a higher risk of occupational burnout than female staff (P<0.01). Medical staff with ≤10 years of work experience had a higher risk of occupational burnout than those with >10 years of work experience(P<0.01). Additionally, medical staff with moral injury had a higher risk of occupational burnout than those without moral injury (P<0.01). Conclusion Occupational burnout is relatively common among medical staff in Dongguan City and is influenced by factors such as gender, working years, moral injury, and others.

BACKGROUND:As tissue engineering brings new hope to the worldwide problem of articular cartilage repair,the construction of light-curing 3D printed hydrogel scaffolds with biomimetic composition is of great significance for cartilage tissue engineering. OBJECTIVE:To construct a biomimetic methacryloylated hyaluronic acid/acellular Wharton's jelly composite hydrogel scaffold by digital light processing 3D printing technology,and to evaluate its biocompatibility. METHODS:Wharton's jelly was isolated and extracted from human umbilical cord,then decellulated,freeze-dried,ground into powder,and dissolved in PBS to prepare 50 g/L acellular Wharton's jelly solution.Methylallylated hyaluronic acid was prepared,lyophilized and dissolved in PBS to prepare 50 g/L methylallylated hyaluronic acid solution.Acellular Wharton's jelly solution was mixed with methacrylyacylated hyaluronic acid solution at a volume ratio of 1:1,and was used as bio-ink after adding photoinitiator.Methylacrylylated hyaluronic acid hydrogel scaffolds(labeled as HAMA hydrogel scaffolds)and methylacrylylated hyaluronic acid/acellular Wharton's jelly gel scaffolds(labeled as HAMA/WJ hydrogel scaffolds)were prepared by digital light processing 3D printing technology,and the microstructure,swelling performance,biocompatibility,and cartilage differentiation performance of the scaffolds were characterized. RESULTS AND CONCLUSION:(1)Under scanning electron microscope,the two groups of scaffolds showed a three-dimensional network structure,and the fiber connection of HAMA/WJ hydrogel scaffold was more uniform.Both groups achieved swelling equilibrium within 10 hours,and the equilibrium swelling ratio of HAMA/WJ hydrogel scaffold was lower than that of HAMA hydrogel scaffold(P＜0.05).(2)CCK-8 assay showed that HAMA/WJ hydrogel scaffold could promote the proliferation of bone marrow mesenchymal stem cells compared with HAMA hydrogel scaffold.Dead/live staining showed that bone marrow mesenchymal stem cells grew well on the two groups of scaffolds,and the cells on the HAMA/WJ hydrogel scaffolds were evenly distributed and more cells were found.Phalloidine staining showed better adhesion and spread of bone marrow mesenchymal stem cells in HAMA/WJ hydrogel scaffold than in HAMA.(3)Bone marrow mesenchymal stem cells were inoculated into the two groups for chondrogenic induction culture.The results of qRT-PCR showed that the mRNA expressions of agglutinoglycan,SOX9 and type Ⅱ collagen in the HAMA/WJ hydrogel scaffold group were higher than those in the HAMA hydrogel scaffold group(P＜0.05,P＜0.01).(4)These findings indicate that the digital light processing 3D bioprinting HAMA/WJ hydrogel scaffold can promote the proliferation,adhesion,and chondrogenic differentiation of bone marrow mesenchymal stem cells.

BACKGROUND:Whether activating transcription factor 7 interacting protein(Atf7ip)is involved in the regulation in osteogenic differentiation is still controversial,and studying its impact on osteogenic differentiation and its specific mechanisms is of great significance. OBJECTIVE:To investigate the effect of Atf7ip on bone morphogenetic protein 2 promoting osteogenic differentiation of mouse embryonic osteoblast precursor cells(MC3T3-E1). METHODS:MC3T3-E1 cells cultured in vitro were divided into three groups:normal group,interference group(NC-siRNA group,Atf7ip-siRNA group),and high expression group(CMV-VC group and CMV-Atf7ip group),and were transfected for 24 hours,and then treated with 200 ng/mL bone morphogenetic protein 2 for 0,12,24,and 48 hours,respectively.qRT-PCR was used to detect the mRNA expression levels of Atf7ip,alkaline phosphatase,osteocalcin,type I collagen α1 in the cells of each group.Western blot assay was used to detect the protein expression of osteogenic differentiation markers Sp7 and Runx2,and the expression of Atf7ip binding molecule SETDB1,histone H3 and H3K9me3.Alkaline phosphatase activity was detected by alkaline phosphatase staining. RESULTS AND CONCLUSION:(1)With the increase of bone morphogenetic protein 2 treatment time,the protein and mRNA expression of Atf7ip decreased,while the protein expression of Sp7,Runx2 and the mRNA expression of osteocalcin and alkaline phosphatase increased significantly(P<0.05).There was no significant change in the protein expression of Atf7ip binding molecule SETDB1.(2)Compared with the NC-siRNA group,the protein expression of Sp7,Runx2 and the mRNA expression of osteocalcin and type I collagen α1 were significantly up-regulated(P<0.05),and alkaline phosphatase activity was significantly enhanced;and H3K9 methylation significantly decreased in the Atf7ip-siRNA group(P<0.05).(3)Compared with the CMV-VC group,the protein expression of Sp7 and Runx,as well as mRNA expression of osteocalcin,alkaline phosphatase,and type I collagen α1 was significantly downregulated(P<0.05),and the alkaline phosphatase activity was significantly reduced in the CMV-Atf7ip group,while the H3K9 methylation protein in the CMV-Atf7ip group was significantly upregulated compared to the control group(P<0.05).(4)In conclusion,Atf7ip expression was decreased during bone morphogenetic protein 2-induced osteogenic differentiation of MC3T3-E1,and osteogenic differentiation was significantly increased after knockdown of Atf7ip.Overexpression of Atf7ip significantly weakened osteogenic differentiation,indicating that Atf7ip is a negative regulatory factor of bone morphogenetic protein 2 promoting osteogenic differentiation of MC3T3-E1 cells.

This article discusses the overview of virtual reality (VR) technology and chronic pain kinesiophobia, elucidating the principles by which VR technology reduces chronic pain kinesiophobia and its effectiveness in the treatment and rehabilitation training of patients with this condition. The advantages and limitations of VR technology are summarized, aiming to provide references for clinical practitioners to better apply VR technology in the treatment and rehabilitation management of chronic pain kinesiophobia. The goal is to improve patients' fear of movement, fear-avoidance beliefs, pain related to movement injuries, physical function, motivation for training, and patient satisfaction.

The anti-tumor effect of anti-PD-1 antibody has long been shown to be strongly related to the tumor immune microenvironment (TIME). This study aimed to mechanistically assess whether Chang Wei Qing (CWQ) Decoction can enhance the anti-tumor effect of PD-1 inhibitor therapy. PD-1 inhibitor therapy showed the significant anti-tumor effect in patients with mismatch repair-deficient/microsatellite instability-high (dMMR/MSI-H) colorectal cancer (CRC), rather than those with mismatch repair-proficient/microsatellite stable (pMMR/MSS) CRC. Hence, immunofluorescence double-label staining was utilized to explore the difference in the TIME between dMMR/MSI-H and pMMR/MSS CRC patients. Flow cytometry was used to analyze T-lymphocytes in tumors from mice. Western blot was used to measure the expression of PD-L1 protein in mouse tumors. The intestinal mucosal barrier of mice was evaluated by hematoxylin-eosin staining and immunohistochemistry. 16S rRNA-gene sequencing was used to examine the structure of the gut microbiota in mice. Subsequently, Spearmanapos;s correlation analysis was used to analyze the relationship between the gut microbiota and tumor-infiltrating T-lymphocytes. The results showed that dMMR/MSI-H CRC patients had more CD8⁺T cells and higher expression of PD-1 and PD-L1 proteins. In vivo, CWQ enhanced the anti-tumor effect of anti-PD-1 antibody and increased the infiltration of CD8⁺ and PD-1⁺CD8⁺ T cells in tumors. Additionally, the combination of CWQ with anti-PD-1 antibody resulted in lower inflammation in the intestinal mucosa than that induced by anti-PD-1 antibody alone. CWQ and anti-PD-1 antibody co-treatment upregulated PD-L1 protein and reduced the abundance of Bacteroides in the gut microbiota but increased the abundance of Akkermansia,Firmicutes, andActinobacteria. Additionally, the proportion of infiltrated CD8⁺PD-1⁺, CD8⁺, and CD3⁺ T cells were found to be positively correlated with the abundance of Akkermansia. Accordingly, CWQ may modulate the TIME by modifying the gut microbiota and consequently enhance the anti-tumor effect of PD-1 inhibitor therapy.
Animals ; Mice ; Immune Checkpoint Inhibitors/therapeutic use* ; Gastrointestinal Microbiome ; CD8-Positive T-Lymphocytes ; B7-H1 Antigen ; RNA, Ribosomal, 16S ; Colorectal Neoplasms/metabolism* ; Colonic Neoplasms ; Tumor Microenvironment

Objective:To investigate the symptom groups and influencing factors in patients with tracheotomy after operation for head and neck cancer and to provide reference for developing accurate symptom management strategies.Methods:Using the convenient sampling method, a total of 289 patients with head and neck cancer who received treatment or reexamination in the First Affiliated Hospital of Zhengzhou University from April 2020 to January 2023 were selected as the research objects. The patients were assessed with the general information questionnaire and M.D. Anderson Symptom Inventory-Head and Neck (MDASI-HN). Exploratory factor analysis was used to analyze the symptom groups of patients with head and neck cancer after tracheotomy, and single factor analysis and decision tree were used to construct the prediction model of each symptom group. A total of 289 questionnaires were sent out in this study, 18 invalid questionnaires were excluded, and 271 valid questionnaires were finally recovered, with an effective recovery rate of 93.8%.Results:Three symptom groups were extracted, including sleep-body symptom group, head and neck cancer radiotherapy-psychological symptom group and head and neck cancer specific symptom group. The decision tree prediction model showed that the core factors affecting the symptoms of patients with tracheotomy after head and neck cancer were disease stage and operation mode, followed by preoperative emotional problems, marital status and main caregivers. The overall correct percentages of the model were 61.6%, 67.2% and 62.0%, respectively, and the correct prediction rates of the non-occurrence candidate symptom groups were respectively 96.1%, 86.4% and 62.4%, indicating a good fitting effect.Conclusions:There are multiple symptom groups in patients with tracheotomy after head and neck cancer surgery. The disease stage and surgical method are the core influencing factors of each symptom group. The decision tree model is helpful for medical staff to effectively identify people with high incidence of various symptom groups and formulate precise intervention plans.

Objective:To speculate the effect of birth spacing on the pelvic floor type Ⅰ and Ⅱ fiber muscle strength of postpartum women with parities of two in different delivery modes.Methods:Totally 2 361 parturients who were investigated in Xuzhou Central Hospital from June 2016 to December 2020 were included in the questionnaire, clinical examination and pelvic floor surface electromyography assessment. According to the interval years between two parities and the pelvic floor typeⅠ and Ⅱ fiber muscle strength under different modes of delivery, curve fitting function equation was performed using curve regression method. The accuracy of the equation was verified by the receiver operating characteristic curve and the maximum area under the curve, and calculating the relative error rate.Results:A total of 2 357 parturients were included in the study and were divided into 4 groups based on delivery modes, women with both normal vaginal delivery were assigned to group A (589 cases); women with a first vaginal delivery and a second cesarean section were assigned to group B (480 cases); women with both cesarean deliveries were assigned to group C (1 273 cases); women with a first cesarean section and a second vaginal delivery were assigned to group D (15 cases). All of the curve fitting results were quadratic curves, and the appropriate interval years were selected when the muscle strength of type Ⅰ muscle fibers was>35 μV and that of type Ⅱ muscle fibers was>40 μV: 6-8 years in the group A, 5-10 years in the group B, and 1-11 years in the group C. The peak values of the quadratic curve were as follows: 7-8 years in the group A, 7-8 years in the group B, and 6 years in the group C. The maximum area under the curve of the function equations were all>0.6 (all P<0.05), the average relative error rate was 4.909%. Conclusions:The pelvic floor function of postpartum women with parities of two increases firstly and then decreases over time, showing a quadratic curve shape. In order to protect the pelvic floor function, the appropriate interval of birth spacing is 6-8 years.

Objective To investigate the clinical value of multidisciplinary team collaboration (MDT)for the treatment of hip fractures in elderly patients.Methods A total of 157 elderly patients with hip fractures meeting inclusion and exclusion criteria were admitted into our department from 1st September 2015 to 31st December 2017.The patients were randomly divided into the traditional treatment group and the MDT group.The differences in treatment time,cost,postoperative outcomes and postoperative Harris hip function score were compared between the two groups.Results The preoperative length of stay,total hospitalization time and the time of antibiotic use after operation were shorter in the MDT treatment group than in the traditional treatment group (all P ＜0.05).Total costs of treatment and costs for bed,laboratory examinations,and nursing were lower in the MDT treatment group than in the traditional treatment group(all P＜0.05).The off-bed activity time after operation was earlier in the MDT treatment group with femoral neck fractures [(5.36 ± 1.56)d vs.(10.07±2.26)d,P =0.002]than in the traditional treatment group with intertrochanteric fracture patients [(30.26 ± 3.01) d vs.(42.28 ± 3.52) d,P =0.017].Harris hip function score was higher in the MDT treatment group than in the traditional treatment group at 3 and 6 months after surgery (P ＜ 0.05).Conclusions As compared with the traditional treatment mode,MDT treatment mode can shorten the preoperative stay in bed,the length of hospital stay after surgery and the off-bed activity time after operation,reduce hospitalization costs and postoperative complications,and can promote the recovery of hip joint function in elderly hip fracture patients.

BACKGROUND: The researches of Pulling and Rotating Oblique Pulling Manipulation focus on clinical research and biomechanical changes of lumbar functional units, and the mechanical characteristics of manipulation are little reported.OBJECTIVE: To study the characteristics of the Pulling and Rotating Oblique Pulling Manipulation by digital method, so as to provide quantitative basis for inheritance, teaching and learning, promotion, and basic research of the manipulation.METHODS: The force-time curve and the force of the manipulators were tested and recorded with the multi-point membrane pressure measurement system. The kinetic parameters (the average load force, the average minimum force and the maximum impact force) were shown. The values of = the flip time, flip speed and impulse were measured by the test analysis system.RESULTS AND CONCLUSION: (1) The average load force was (145.86±34.80) N, duration was (1.43±0.46) s, the average minimum force was (72.24±13.87) N, the maximum impact force was (446.21±143.98) N, the flip time was (0.55±0.15) s, flip speed was (914.52±259.18) N/s, and the impulse was (256.21±82.30) N?s. (2) The rising slope of the impulse was (93.96±6.94), and the falling slope was (-82.70±26.10). (3) To conclude, the characteristics of manipulation from hand are analyzed in views of digitization, which provides an objective evaluation index for Lin's manipulation.

Spastic-paralysis impacts the function of upper extremity in most apoplexy patients.Assessing spasticity condition precisely,timely and effectively plays an important role in guiding rehabilitation treatment,therapeutic evaluation and prognosis of functional outcome.Owing to the limitations of subjective scales,the issue of quantifing the spasticity objectively has become a new research direction in recent years.By reviewing the literatures,we summed up the application of objective assessment tools,which were based on rehabilitation engineering,electrophysiology or biomechanics,in assessing the function of upper extremity with spastic paralysis,as well as put forward the research directions of prospects,in order to give a reference to the systematic integration of assessment tools in the near future.