Objective:To investigate the clinical and pathological significance of the DICER1 mutation in follicular thyroid carcinoma (FTC).Methods:Sixty-eight cases of primary FTC resected between 2009 and 2023 were retrieved from The Affiliated Hospital of Qingdao University, Qingdao, China. Sanger sequencing was performed to identify DICER1 and TERT promoter mutations in all cases. Cases with DICER1 or TERT promoter mutations were subject to additional examination of potential mutations in KRAS, HRAS, and NRAS. The clinical and pathological features of DICER1-mutant FTCs were then analyzed. The relationship between DICER1 mutations and TERT-promoter/RAS mutations was also assessed.Results:DICER1 mutations were detected in 16 of the 68 FTC cases (23.5%), with 11 near E1813 at exon 25, 6 near D1709 at exon 24, and 1 in the splice region of exon 25. Two cases harbored two (distinct) mutations. All patients with DICER1-mutant FTC were female. Compared with patients with DICER1-wild-type FTC, those with DICER1-mutant were much younger, and had a higher proportion of minimally invasive subtype. Nine FTCs with DICER1 mutations were subject to further sequencing on adjacent non-cancerous tissues or lymph node tissues, but no mutations were detected. TERT-promoter or RAS hotspot mutations were not identified in any of the DICER1-mutant cases. However, TERT-promoter mutation was found in 6 DICER1-wild-type cases (8.8%, 6/68), with 3 cases also having RAS hotspot mutations and exhibiting highly aggressive biological behaviors.Conclusion:DICER1 mutations may occur in FTCs and appear mutually exclusive with RAS and TERT-promoter mutations, warranting further study as RAS-like mutations.

Objective To study the application value of the supraclavicular and anterior sternocleidomastoid space approach in open thyroid cancer surgery.Methods A retrospective study of 65 patients with thyroid cancer from January 2023 to December 2023 was conducted,the patients were divided into experimental group(30 cases)and control group(35 cases),which received thyroid cancer operation via supraclavicular and Sternocleidomastoid muscle anterior space approach and conventional open thyroid cancer operation respectively.The perioperative period,quality of life,pain and complications were compared between the two groups.Results The incision length,the number of lymph nodes removed,the operation time,the blood loss,the drainage volume,the drainage time and the hospital stay in the observation group were(4.00±0.76)cm,(6.41±0.73),(66.32±2.93)minutes,(37.14±6.69)mL,(1.41±0.59)days and(16.68±1.9),respectively 1)ml and(5.14±1.25)days.The control groups were(5.54±1.03)cm,(4.31±0.68)pieces,(80.42±2.96)minutes,(55.54±2.67)ml,(3.15±0.67)days,(31.19±1.96)ml and(7.88±1.28)days respectively.There was a statistically significant difference between the two groups(P＜0.001).Under the effects of interaction,time point effect and inter-group effect,the EQ-5D-5L scale and NRS score will change with the time point variation due to different surgical methods.The incidences of choking cough when drinking water,neck tightness sensation and total adverse events in the observation group were lower than those in the control group,and the difference was statistically significant(P＜0.001).Conclusion The supraclavicular and anterior sternocleidomastoid approach can reduce the length of incision,shorten the operation time,reduce postoperative pain and complications,and improve the quality of life of patients with thyroid cancer.

Objective To study the application value of the supraclavicular and anterior sternocleidomastoid space approach in open thyroid cancer surgery.Methods A retrospective study of 65 patients with thyroid cancer from January 2023 to December 2023 was conducted,the patients were divided into experimental group(30 cases)and control group(35 cases),which received thyroid cancer operation via supraclavicular and Sternocleidomastoid muscle anterior space approach and conventional open thyroid cancer operation respectively.The perioperative period,quality of life,pain and complications were compared between the two groups.Results The incision length,the number of lymph nodes removed,the operation time,the blood loss,the drainage volume,the drainage time and the hospital stay in the observation group were(4.00±0.76)cm,(6.41±0.73),(66.32±2.93)minutes,(37.14±6.69)mL,(1.41±0.59)days and(16.68±1.9),respectively 1)ml and(5.14±1.25)days.The control groups were(5.54±1.03)cm,(4.31±0.68)pieces,(80.42±2.96)minutes,(55.54±2.67)ml,(3.15±0.67)days,(31.19±1.96)ml and(7.88±1.28)days respectively.There was a statistically significant difference between the two groups(P＜0.001).Under the effects of interaction,time point effect and inter-group effect,the EQ-5D-5L scale and NRS score will change with the time point variation due to different surgical methods.The incidences of choking cough when drinking water,neck tightness sensation and total adverse events in the observation group were lower than those in the control group,and the difference was statistically significant(P＜0.001).Conclusion The supraclavicular and anterior sternocleidomastoid approach can reduce the length of incision,shorten the operation time,reduce postoperative pain and complications,and improve the quality of life of patients with thyroid cancer.

Objective:To investigate the clinical and pathological significance of the DICER1 mutation in follicular thyroid carcinoma (FTC).Methods:Sixty-eight cases of primary FTC resected between 2009 and 2023 were retrieved from The Affiliated Hospital of Qingdao University, Qingdao, China. Sanger sequencing was performed to identify DICER1 and TERT promoter mutations in all cases. Cases with DICER1 or TERT promoter mutations were subject to additional examination of potential mutations in KRAS, HRAS, and NRAS. The clinical and pathological features of DICER1-mutant FTCs were then analyzed. The relationship between DICER1 mutations and TERT-promoter/RAS mutations was also assessed.Results:DICER1 mutations were detected in 16 of the 68 FTC cases (23.5%), with 11 near E1813 at exon 25, 6 near D1709 at exon 24, and 1 in the splice region of exon 25. Two cases harbored two (distinct) mutations. All patients with DICER1-mutant FTC were female. Compared with patients with DICER1-wild-type FTC, those with DICER1-mutant were much younger, and had a higher proportion of minimally invasive subtype. Nine FTCs with DICER1 mutations were subject to further sequencing on adjacent non-cancerous tissues or lymph node tissues, but no mutations were detected. TERT-promoter or RAS hotspot mutations were not identified in any of the DICER1-mutant cases. However, TERT-promoter mutation was found in 6 DICER1-wild-type cases (8.8%, 6/68), with 3 cases also having RAS hotspot mutations and exhibiting highly aggressive biological behaviors.Conclusion:DICER1 mutations may occur in FTCs and appear mutually exclusive with RAS and TERT-promoter mutations, warranting further study as RAS-like mutations.

Objective:To investigate the efficacy and value of preemptive analgesia in older adult patients undergoing laparoscopic hepatectomy.Methods:A total of 150 older adult patients with liver cancer, who underwent laparoscopic hepatectomy at The 2 nd Affiliated Hospital of Wenzhou Medical University between July 2019 and April 2020, were randomly assigned to two groups: a control group ( n = 75) and an observation group ( n = 75) using the random number table method. The control group received postoperative analgesia with parecoxib sodium, while the observation group received preemptive analgesia with parecoxib sodium. A comparative analysis was conducted between the control and observation groups in terms of the Numerical Rating Scale (NRS) scores at 8, 12, and 24 hours postoperatively, postoperative recovery, length of hospital stay, and overall cost. Results:There were no statistically significant differences in operation time, dosage of Sufentanil 24 hours postoperatively, or the total and effective usage counts of patient-controlled intravenous analgesia with Sufentanil between the control and observation groups (both P > 0.05). However, the NRS scores of the observation group were significantly lower than those of the control group at 8, 12, and 24 hours postoperatively. Specifically, the NRS scores of the observation group were (4.38 ± 1.24) points, (3.41 ± 0.19) points, and (2.90 ± 0.17) points, respectively, while those of the control group were (5.24 ± 1.01) points, (4.65 ± 1.24) points, and (3.32 ± 1.00) points, respectively ( t = 4.66, 8.56, 3.59, all P < 0.001). Patients in the observation group exhibited significantly more frequent off-bed activities [(2.62 ± 1.24) times], a notably longer cumulative duration of off-bed activities [(1.36 ± 0.20) hours], and a significantly shorter duration of first anal exhaust [(13.50 ± 1.27) hours] compared with those in the control group [(1.06 ± 0.12) times, (0.36 ± 0.09) hours, (20.10 ± 2.16) hours, t = -10.84, -39.49, 22.81, all P < 0.001]. Furthermore, the observation group demonstrated a shorter postoperative hospital stay [(8.90 ± 1.34) days], lower hospitalization costs [(55.8 ± 2.1) thousand yuan], and higher patient satisfaction scores [(88.98 ± 5.64) points] compared with the control group [(11.15 ± 1.29) days, (59.4 ± 6.2) thousand yuan, (72.16 ± 3.26) points, t = 10.48, 4.76, -22.36, all P < 0.001]. Conclusion:The implementation of preemptive analgesia intervention among older adult patients undergoing laparoscopic hepatectomy effectively enhances analgesic outcomes, accelerates postoperative recovery, reduces hospitalization duration, and markedly decreases hospitalization costs.

Objective:To explore the effect of nursing intervention based on forgetting curve theory on disease knowledge level and self-management ability of patients with acute pancreatitis.Methods:Using the convenient sampling method, a total of 152 patients with acute pancreatitis who were admitted to the Second Affiliated Hospital of Wenzhou Medical University were selected as the research objects from January 2018 to June 2020. According to the random number table, the research objects were divided into the control group and the observation group, with 76 cases in each group. Patients in the control group were treated with routine nursing interventions, while patients in the observation group were given nursing interventions based on the forgetting curve theory. The intervention time was 1, 2, 4, 7 and 15 days after hospitalization. The self-made Acute Pancreatitis Knowledge Questionnaire and Self-management Questionnaire were used to evaluate the disease knowledge and self-management ability of patients in the two groups before the intervention, 7 days after the intervention, 1 and 3 month after the intervention.Results:There was no statistically significant difference in the acute pancreatitis knowledge scores between the two groups before intervention ( t=0.368, P=0.714) . The acute pancreatitis knowledge scores of patients in the observation group after 7 days of intervention and 1 and 3 months after intervention were higher than those of the control group at the same time, and the differences were statistically significant ( t=5.067, 4.718, 6.361; P<0.01) . There was no statistically significant difference in scores of self-management level of acute pancreatitis of patients between the two groups before intervention ( t=0.160, P=0.873) . The self-management scores of patients in the observation group for acute pancreatitis after 7 days of intervention and 1 and 3 months after intervention were higher than those of the control group at the same time, and the differences were statistically significant ( t=6.379, 7.757, 7.735; P<0.01) . Conclusions:The application of nursing intervention based on forgetting curve theory for patients with acute pancreatitis can improve the disease knowledge level of patients and enhance the self-management ability of them, which is of great significance for patients to maintain their long-term memory of knowledge related to acute pancreatitis.

Objective To explore the current status and influencing factors of subjective well-being (SWB) in student nurses so as to provide a basis for formulating corresponding countermeasures.Methods A total of 652 student nurses at a classⅢ grade A hospital in Wenzhou City were selected as subjects by chester sampling from January 2015 to January 2017. They were investigated with the general condition questionnaire and the Chinese version of the Warwick-Edinburgh mental well-being scale (WEMWBS) . Results The total score of WEMWBS was (51.29±9.34) with a middle level in student nurses. Belief, self-report character, sexes, annual household income, body mass index had influences on SWB of student nurses (P<0.01).Conclusions The level of SWB of student nurses needs to be improved. Nurse educators and managers should pay high attention to mental health of student nurses and take positive measures to improve the SWB of student nurses so as to stabilize the construction of nursing team.

Objective To explore the influence of double tutor teaching model on nursing students'ideological quality and comprehensive ability cultivation in nursing clinical teaching. Methods From July 14th,2015 to April 24th,2016,a total of 136 full-time undergraduate nursing students in the Second Affiliated Hospital of Wenzhou Medical University were randomly divided into experimental group (n=68) and control group (n=68) according to random number table method. Post tutor teaching mode was applied as clinical teaching method in the control group,while double tutor teaching mode was administered in the experimental group. Theory,nursing intervention had been tested in each ward during internship for both two groups as well as a unified practice examination form for comprehensive evaluation. Results Theoretical score,operation score,comprehensive evaluation,general scores of the experimental group students were higher than those of the control group (t=27.52,14.82,13.89,14.95;P<0.01). Conclusions Application of double tutorial system teaching mode in clinical nursing practice is conductive to improve theoretical knowledge,operation skills,strengthen the ideological quality of nursing students as well as to elevate their ability of observation,learning,adaptation and communication.

Objective To discuss the influence of the holistic nursing careng on clinical value in patients with advanced pancreatic cancer.Methods 70 patients with pancreatic cancer were randomly divided into the observation group and the control group,with 35 cases in each group.The control group was given routine nursing measures.The observation group received the holistic nursing careng on the basis of routine nursing measures.The hospitalization time,satisfaction degree,treatment compliance and mentality were observed.Results The SAS,SDS scores of the observation group after nursing were (56.87 ±6.01)points and (61.79 ±6.17)points,which were significantly lower than (39.11 ±5.68)points and (40.82 ±5.31)points of before nursing(t =9.136,8.561,all P <0.05).The hospi-talization time,exhaust time of the observation group were (32.9 ±6.6)days and (8.21 ±1.29)days,which were significantly lower than (45.1 ±10.2)days and (13.56 ±1.77)days of the control group(t =8.561,3.769,all P <0.05).The treatment satisfaction and treatment compliance in the observation group were also significantly better than the control group(χ2 =8.292,8.156,all P <0.05).Conclusion Hsystematic nursing intervention can significantly improve thepostoperative anxiety and depression,and improve the quality of life of patients with severe pneumonia.

Objective To explore the influence of the dual tutorial teaching mode on the undergraduate
nursing students′ critical thinking in the clinical training. Methods Two hundred and sixteen full-time undergraduate nursing students who did internships in the second Affiliated Hospital of Wenzhou Medical University from September 1st, 2013 to September 1st, 2015 were divided into the experimental group ( n=111) and the control group ( n=105) using the random number table. The nursing students in the control group received the traditional post tutor teaching mode, while the nursing students in the experimental group received the dual tutorial system teaching mode in the clinical teaching. After the internship, nursing students in the two groups completed the general information questionnaire and the critical thinking disposition inventory.Results The scores of critical thinking ability, open-minded ability, analytical ability, systematic ability, critical thinking self-confidence, curiosity, cognitive maturity dimension of the nursing students in the experimental group were (280.32±29.83), (40.53±5.75), (43.08±5.32), (37.69±6.08), (40.16±5.60), (43.89±6.71), (38.53± 7.17) respectively, which were significantly higher than the scores gained by the nursing students in the control group (t=-7.587, -6.138, -8.555, -3.530, -6.727, -8.023, -3.097;P<0.05).In the control group, they were (210.63±25.25), (29.86±6.31), (26.61±5.71), (32.19±6.17), (28.76±5.82), (25.96±6.53), (32.99±7.41), respectively.Conclusions The dual tutorial teaching mode improves undergraduate nursing trainees′critical thinking ability including open-minded ability, analytical ability, systematic ability, critical thinking self-confidence, curiosity, cognitive maturity, which can be applied in the clinical teaching of nursing students.