Objective:To develop an electronic information platform-based assessment tool for entrustable professional activities (EPAs) of master of nursing specialist (MNS) students.Methods:The study used the content analysis method to construct the draft of the assessment tool, which was finalized using the expert meeting method. An electronic information platform was developed based on the assessment tool. The functions of the platform was optimized using the focus group interview method.Results:Based on previous research on the EPA framework for MNS students, an EPA assessment tool was developed, including an assessment form and an assessment protocol. The assessment form consisted of three parts: description of the EPAs, supervision level, and narrative feedback. The assessment protocol covered the assessment objects, assessment initiation strategy, assessment implementation-entrustment decision making, assessment cycle, and quality control. The electronic information platform includes both web-based and mobile app interfaces, with user roles for clinical instructors, graduate students, and project administrators, and with functions such as assessment application, assessment initiation, historical assessment review, and assessment information management.Conclusions:The study developed an EPA assessment tool for MNS students. The tool relies on the convenience and efficiency of the electronic information platform, facilitates clinical instructors in observing the comprehensive performance of MNS students in multiple competencies, and promotes postgraduate students' professional development. Future research will further explore the effectiveness of this tool in assessing clinical practice competencies of MNS students, with the aim of advancing the practice of EPAs in nursing masters' education.

Objective:To develop an electronic information platform-based assessment tool for entrustable professional activities (EPAs) of master of nursing specialist (MNS) students.Methods:The study used the content analysis method to construct the draft of the assessment tool, which was finalized using the expert meeting method. An electronic information platform was developed based on the assessment tool. The functions of the platform was optimized using the focus group interview method.Results:Based on previous research on the EPA framework for MNS students, an EPA assessment tool was developed, including an assessment form and an assessment protocol. The assessment form consisted of three parts: description of the EPAs, supervision level, and narrative feedback. The assessment protocol covered the assessment objects, assessment initiation strategy, assessment implementation-entrustment decision making, assessment cycle, and quality control. The electronic information platform includes both web-based and mobile app interfaces, with user roles for clinical instructors, graduate students, and project administrators, and with functions such as assessment application, assessment initiation, historical assessment review, and assessment information management.Conclusions:The study developed an EPA assessment tool for MNS students. The tool relies on the convenience and efficiency of the electronic information platform, facilitates clinical instructors in observing the comprehensive performance of MNS students in multiple competencies, and promotes postgraduate students' professional development. Future research will further explore the effectiveness of this tool in assessing clinical practice competencies of MNS students, with the aim of advancing the practice of EPAs in nursing masters' education.

Objective:To retrospectively assess early risk factor of persistent inflammation, immunosuppression and catabolism syndrome (PICS) in patients with severe polytrauma, in order to deepen the understanding of the pathological changes of chronic critical illness (CCI) after severe polytrauma.Methods:A total of 276 patients with severe polytrauma admitted to Department of Trauma Surgery of Tongji Hospital from March 2019 to December 2020 were enrolled. Inclusion criteria included patients who suffered severe polytrauma, and injury severity score (ISS) ≥27, age ≥18 years old, and had length of hospital stay >15 days. Exclusion criteria included previous medical history of malignancy, or immunological, consumptive, and metabolic diseases. The patient’s clinical characteristics, ISS scores, Glasgow coma scale (GCS), sequential organ failure assessment, APACHEⅡ scores, and nutrition and immune indexes on day 3 after injury were collected. The difference between the PICS group and N-PICS group were performed by Student’s t test, χ2 test or Mann-Whitney U test. The early risk factors were assessed in patients with PICS after severe polytrauma by logistic regression analysis. Results:According to the diagnostic criteria of PICS, all enrolled patients were divided into two groups: PICS group ( n=102) and N-PICS group (without PICS, n=174). Compared with the N-PICS group, patients in the PICS group were older and associated with more brain and chest injuries. On the third day after injury, serum levels of IL-6 and IL-10, and the ratio of Treg cells were significantly higher, the number and ratio of NK cells subset, and the ratio of activated T lymphocyte were significantly lower in the PICS group than in the N-PICS group ( P<0.05). Logistic regression analysis showed that the age>65 years old ( OR=2.375, 95% CI: 1.442-4.531), GCS ≤8 scores ( OR=3.431, 95% CI: 1.843-8.512), IL-10 >10 pg/mL ( OR=2.173, 95% CI: 1.751-5.614), the ratio of Treg cells >7% ( OR=3.871, 95% CI: 1.723-6.312), and the occurrence of traumatic brain and chest injuries ( OR=2.846, 95% CI: 1.522-5.361) were the early risk factors in patients with PICS after severe polytrauma. Conclusions:Age>65 years old, GCS score, IL-10, the ratio of Treg cells, and the occurrence of traumatic brain and chest injuries could be used as the early risk factors in patients with PICS after severe polytrauma. The discovery of early risk factors will help identify patients at high risk of PICS after severe polytrauma, and create the possibility for early intervention.

Objective:To retrospectively assess the relationship between immune disorder and acute gastrointestinal injury (AGI) in patients after severe polytrauma.Methods:Totally 205 patients with severe polytrauma admitted to Tongji Hospital from April 2018 to October 2019 were enrolled as the observation group, and 23 healthy volunteers were served as the control group. According to the diagnostic criteria of AGI, all patients were divided into the AGI group (with AGI) or N-AGI group (without AGI), AGI patients were divided into the S-AGI group or L-AGI group according to the severity. The levels of cytokines and lymphocyte subset were evaluated at day 1, 7, and 14 after severe polytrauma. The differences between groups were statistically analyzed. The independent risk factors of AGI were analyzed by Logistic regression analyzed.Results:Totally 79.5% (163/205) of patients with severe polytrauma were accompanied by AGI. There were significant differences in the ratio of Tc, Th at day 1 after trauma, the levels of IL-6, TNF-α, IL-8, IL-10, the ratio of Ts, Th/Ts, Treg at day 7 after trauma, and the levels of IL-8, IL-10,the ratio of Ts, Th/Ts, Treg at day 14 after trauma between the AGI group and N-AGI group ( P<0.05). There were significant differences in the ratio of Tc, Th, the levels of IL-6, TNF-α at day 1 after trauma and the ratio of Ts, Th/Ts, Treg, the levels of IL-8, IL-10 at day 7 and 14 after trauma between the S-AGI group and L-AGI group ( P<0.05). Logistic regression analysis showed that Ts 7 d ( OR=2.018, 95% CI: 1.105-5.364, P=0.013), Treg 14 d ( OR=3.612, 95% CI: 1.375-8.476, P=0.006), IL-6 7 d ( OR=1.824, 95% CI: 1.011-5.835, P=0.024), IL-10 14 d ( OR=2.847, 95% CI: 1.241-6.216, P=0.014), TNF-α 7 d ( OR=1.754, 95% CI: 1.215-5.441, P=0.018) were independent risk factors in patients with AGI after severe polytrauma. Conclusions:AGI is more easily occurred in patients with the heavier immune disorders after severe polytrauma. AGI can also aggravate pre-existing immune disorders in patients after severe polytrauma.

From August 21 to December 13, 2018, a tetramine poisoning incident in Wenzhou, Zhejiang Province was investigated, and the clinical diagnosis and treatment of tetramine poisoning was analyzed. There were 6 cases of poisoning caused by artificial tetramine poisoning. The diagnosis was delayed, coma and convulsions were severe manifestations continuous renal replacement therapy (CRRT) was effective in the treatment of severe cases, and all 6 cases were cured. The possibility of poisoning should be considered for unexplained coma and/or convulsions. Although tetramine is banned, it still needs to be highly vigilant and avoids the recurrence of delayed diagnosis and treatment.

From August 21 to December 13, 2018, a tetramine poisoning incident in Wenzhou, Zhejiang Province was investigated, and the clinical diagnosis and treatment of tetramine poisoning was analyzed. There were 6 cases of poisoning caused by artificial tetramine poisoning. The diagnosis was delayed, coma and convulsions were severe manifestations continuous renal replacement therapy (CRRT) was effective in the treatment of severe cases, and all 6 cases were cured. The possibility of poisoning should be considered for unexplained coma and/or convulsions. Although tetramine is banned, it still needs to be highly vigilant and avoids the recurrence of delayed diagnosis and treatment.

Objective To explore the expressions ofβ-catenin in gastric adenocarcinoma primary tumors and metastatic lymph nodes,and to determine if it is associated with infiltration degree and whether it can provide the basis for gastric cancer metastasis.Methods The expressions ofβ-catenin were detected in 156 patients with gastric adenocarcinoma specimens,40 cases with the corresponding lymph nodes and 12 cases of normal gastric tissues by the method of immunohistochemistry.The expressions ofβ-catenin in gastric adenocarcinoma and corre-sponding lymph node metastases were analysed.The relationship between the expression of β-catenin and the clinical pathological features of gastric adenocarcinoma was ascertained,and difference between them was observed.Results The positive expression rate ofβ-catenin in normal gastric tissue membrane was 100.0%(12/12).The expression rate ofβ-catenin was 29.5%(46/156)in adenocarcinoma cell membrane,and it was 10.0%(4/40)in metastatic lymph nodes cell membrane.The positive expression ofβ-catenin was not associated with patient′s age(χ2 =2.160,P=0.142),gender (χ2 =1.229,P=0.268),but it was associated with tumor infiltration degree (χ2 =4.032,P=0.045 ),degree of tumor differentiation (χ2 =6.093,P=0.048),tumor stage (χ2 =4.591,P=0.032),and metastasis lymph nodes (χ2 =4.485,P=0.034).The incidence of abnor-mal or loss expression ofβ-catenin in gastric adenocarcinoma metastatic lymph nodes was higer than that in gastric adenocarcinoma (χ2 =6.362,P=0.012).Conclusion The expression of β-catenin will be a great help to judge the biological behaviors such as the malignant degree of tumor and the capacity of tumor invasion and metas-tasis.

Objective To explore the relationship between TGF-beta1,BRCA2,HER2,ER,PR and clinical factors in breast cancer.Methods The expression of TGF-beta1,BRCA2,HEB2,ER,PB in 67 cases breast carcinoma were detected by immunohistochemistry staining SP method.The correlation of the results with other parameters which included age,pathohistological grade,status of auxiliary lymph nodes were analyzed by mono-factor unconditional logistic regression analysis.Results The expression of TGF-beta1 was correlated with BRCA2.and the expression of BRCA2 was correlated with TGF-beta1 and c-erbB-2 in breast cancer.Condusion Overexpression of BRCA2 was related with TGF-beta1 and HER2 in breast carcinoma.It was useful in breast carcinoma prognosis by detecting these three factors.

Objective:To investigate the expression of Oct4 and Wnt2 in human glioma tissues and its relationship with the clinicopathological features of glioma. Methods: Fifty-six paraffin blocks were obtained from glioma patients receiving surgery. The diagnosis of these patients were confirmed by pathology in our hospital from 2006-2009. Immunohistochemi-cal staining was used to examine Oct4 and Wnt2 expression in the brain tissues of 10 patients with acute brain injury and 56 glioma tissues (including 15 recurrent cases). Results: The normal brain tissues were negative of Oct4, with only one case showing weak Wnt2 expression. Thirty-four of the 56 glioma tissues showed positive expression of Oct4 (60.7%), and 40 showed positive expression of Wnt2 (71.4%). Positive expression rates of Oct4 and Wnt2 in low-grade and high-grade glioma tissues were 46.2 %, 73.3% and 57.7 %, 83.3%, respectively (P < 0.05). Oct4 positive rates in the recrudescence and newly diagnosed glioma tissues were 86.7% and 51.2%, respectively (P < 0.05). Oct4 expression in the glioma tissues was positively correlated with that of Wnt2 (r = 0.537, P < 0.01). Conclusion: Expression of Oct4 and Wnt2 is associated with the malignant degrees of glioma, and Oct4 expression is related to the recurrence of glioma. Oct4 might participate in the development and progression of brain glioma through Wnt signaling pathway.