Objective To explore the effect of organizational climate on work alienation in psychiatric nurses,and the mediating role of psychological capital and positive coping styles between organizational climate and work alienation,in order to provide a reference for reducing work alienation among psychiatric nurses.Methods Convenience sampling method was used to select nurses working in 6 tertiary A psychiatric hospitals in Shandong Province from January to July 2024,and the general questionnaire,Nurses' Work Alienation Questionnaire,Organizational Climate Scale for Nursing,Psychological Capital Questionnaire,and Simple Coping Style Scale were used to conduct the survey and the mediation effect test.Results A total of 606 questionnaires were recovered,of which 572 were valid,and the validity rate of the questionnaires was 94.39％.Psychiatric nurses scored(89.58±13.69)for nursing organizational climate,(32.48±11.31)for work alienation,(97.28±19.12)for psychological capital,and(23.93±7.22)for positive coping styles.There was a direct effect of nursing organizational climate on work alienation(β=-0.681,95％CI=-0.824～-0.539).Psychological capital and positive coping styles acted as separate mediators and chain mediators in the effect of nursing organizational climate on work alienation(β=-0.116,-0.048,-0.019,95％CI=-0.182～-0.034,-0.086～-0.006,-0.042～-0.002).Conclusion There are multiple mediating effects of psychiatric nurses' psychological capital,positive coping styles between nursing organizational climate and work alienation.Nursing managers can enhance psychiatric nurses' psychological capital by creating a positive and healthy organizational climate,encouraging them to adopt positive coping styles to solve problems,and reducing work alienation.

Immunoinflammation mediates the development of hypertensive nephropathy,and aberrant activation of the complement system,an important component of the innate immune system,plays an important role in the development of hypertensive nephropathy.Complement inhibition is expected to be a potential strategy for the treatment of hypertensive nephropathy.In this article,we summarized and reviewed relevant studies on the complement system in the development of hypertensive nephropathy,and complement-targeted drug therapy,aiming to provide new ideas for clinicians on the clinical diagnosis and treatment of hypertensive nephropathy.

Immunoinflammation mediates the development of hypertensive nephropathy,and aberrant activation of the complement system,an important component of the innate immune system,plays an important role in the development of hypertensive nephropathy.Complement inhibition is expected to be a potential strategy for the treatment of hypertensive nephropathy.In this article,we summarized and reviewed relevant studies on the complement system in the development of hypertensive nephropathy,and complement-targeted drug therapy,aiming to provide new ideas for clinicians on the clinical diagnosis and treatment of hypertensive nephropathy.

Objective To explore the effect of organizational climate on work alienation in psychiatric nurses,and the mediating role of psychological capital and positive coping styles between organizational climate and work alienation,in order to provide a reference for reducing work alienation among psychiatric nurses.Methods Convenience sampling method was used to select nurses working in 6 tertiary A psychiatric hospitals in Shandong Province from January to July 2024,and the general questionnaire,Nurses' Work Alienation Questionnaire,Organizational Climate Scale for Nursing,Psychological Capital Questionnaire,and Simple Coping Style Scale were used to conduct the survey and the mediation effect test.Results A total of 606 questionnaires were recovered,of which 572 were valid,and the validity rate of the questionnaires was 94.39％.Psychiatric nurses scored(89.58±13.69)for nursing organizational climate,(32.48±11.31)for work alienation,(97.28±19.12)for psychological capital,and(23.93±7.22)for positive coping styles.There was a direct effect of nursing organizational climate on work alienation(β=-0.681,95％CI=-0.824～-0.539).Psychological capital and positive coping styles acted as separate mediators and chain mediators in the effect of nursing organizational climate on work alienation(β=-0.116,-0.048,-0.019,95％CI=-0.182～-0.034,-0.086～-0.006,-0.042～-0.002).Conclusion There are multiple mediating effects of psychiatric nurses' psychological capital,positive coping styles between nursing organizational climate and work alienation.Nursing managers can enhance psychiatric nurses' psychological capital by creating a positive and healthy organizational climate,encouraging them to adopt positive coping styles to solve problems,and reducing work alienation.

Objective:To explore the effects of canagliflozin on cardiac function and its regulation of ferroptosis in rats with heart failure with preserved ejection fraction (HFpEF).Methods:Thirty-two 7-week-old Dahl salt-sensitive rats were selected and randomly divided into four groups: the control group (fed with low-salt diet), the HFpEF group (fed with high-salt diet), the canagliflozin 20 group (fed with high-salt diet and 20 mg·kg -1·d -1 canagliflozin), and the canagliflozin 30 group (fed with high-salt diet and 30 mg·kg -1·day -1 canagliflozin). Body weight and blood pressure of the rats in each group were monitored. Metabolic cage tests were conducted at the10 th week of the experiment, and echocardiography was performed at the 12 th week, after which the rats were killed. Blood and left ventricular samples were collected. HE staining, Masson staining, Prussian blue iron staining, and reactive oxygen species staining were performed to observe the cardiomyocyte size and shape, degree of interstitial fibrosis, iron staining, reactive oxygen species production under optical microscope. The ultrastructure of cardiomyocytes was observed under electron microscope. Western blotting and real-time fluorescent quantitative reverse transcription polymerase chain reaction (RT-qPCR) were used to detect the expression levels of proteins and mRNA related to ferroptosis in left ventricular myocardial tissue of rats in each group. Results:After 1 week of adaptive feeding, all rats survived. Metabolic cage results showed that compared with control group, rats in the HFpEF group, canagliflozin 20 group and canagliflozin 30 group had more food intake, water intake and urine output, and lower body weight (all P<0.05). These changes were more pronounced in canagliflozin 20 group and canagliflozin 30 group than in HFPEF group, and only the body weight at the 12 th week showed a statistically significant difference between canagliflozin 20 group and canagliflozin 30 group ( P<0.05). The blood pressure of 6 th week and 12 th week, heart weight and left ventricular corrected mass of 12 th week of rats in HFpEF group were higher than those in control group, canagliflozin 20 group and canagliflozin 30 group, while the ratio of early mitral valve peak velocity to late mitral valve peak velocity of 12 th week was lower (all P<0.05). HE and Masson staining showed that compared to control group, the myocardial fibers in the left ventricular myocardial tissue of rats in HFpEF group were disordered, with larger cell diameter ((0.032±0.004) mm vs. (0.023±0.003) mm, P<0.05), irregular shape, obvious proliferation of interstitial collagen fibers, and higher collagen volume fraction (0.168±0.028 vs. 0.118±0.013, P<0.05). Compared with HFpEF group, rats in the canagliflozin 20 group and canagliflozin 30 had more orderly arranged myocardial fibers, more regular cardiomyocyte shape, smaller cell diameter, and lower collagen volume fraction ( P<0.05). It was observed under electron microscopy that, compared to control group, most of the striated muscles in myocardial tissue of HFpEF group were broken, and the Z line and M line could not be clearly distinguished, some changes such as mitochondrial swelling, membrane thickening, cristae reduction or even disappearance occurred. In the canagliflozin 20 group and canagliflozin 30 group, the arrangement of striated muscles in the myocardial tissue of rats tended to be more regular, and the morphological changes of mitochondria were milder. Prussian blue iron staining results showed that the iron content in myocardial tissue of rats in HFpEF group was higher than that in control group, canagliflozin 20 group and canagliflozin 30 group. Reactive oxygen species staining results showed that the reactive oxygen species content in the myocardial tissue of rats in HFpEF group was higher than that of control group, canagliflozin 20 group and canagliflozin 30 group. Biochemical analysis of myocardial tissue showed that Fe 2+ and malondialdehyde content in myocardial tissue of rats in HFpEF group were higher than those in control group, canagliflozin 20 group and canagliflozin 30 group, while glutathione content was lower (all P<0.05). Western blot and RT-qPCR detection results showed that compared to control group, rats in HFpEF group had higher expression levels of transferrin receptor 1 (protein relative expression level: 1.37±0.16 vs. 0.31±0.12), acyl-CoA synthetase long-chain family member 4 (protein relative expression level: 1.31±0.15 vs. 0.63±0.09) protein and mRNA, and lower expression levels of ferritin heavy chain 1 (protein relative expression level: 0.45±0.08 vs. 1.41±0.15) protein and mRNA (all P<0.05). There was no statistically significant difference in these indicators between canagliflozin 20 group and the canagliflozin 30 group (all P>0.05). There was no significant difference in levels of glutathione peroxidase 4 protein and mRNA expression in myocardial tissue of rats in four groups( P>0.05). Conclusion:Canagliflozin improves cardiac function in HFpEF rats by regulating the ferroptosis mechanism.

Objective:To observe any effects of contralateral repeated transcranial magnetic stimulation (rTMS) of the swallowing motor cortex on the swallowing and brainstem auditory evoked potentials (BAEPs) of stroke survivors with dysphagia.Methods:A total of 83 stroke survivors with dysphagia were randomly divided into an ipsilesional stimulation group ( n=22), a contralesional stimulation group ( n=21), a bilateral stimulation group ( n=20), and a control group ( n=20). In addition to their conventional dysphagia training, those in the three stimulation groups received 3Hz rTMS while the control group was given fake stimulation. The treatment was administered daily for 20 minutes, 6 days a week, for 5 consecutive weeks. Before and after the treatment, swallowing function was assessed videofluoroscopically and using the Dysphagia Outcome and Severity Scale (DOSS). The oral and pharyngeal stages of swallowing were evaluated using the videofluoroscopic dysphagia scale (VDS). Brain stem conduction was assessed using BAEPs. Results:After treatment the average DOSS scores of all 4 groups were significantly better than before the treatment. The average DOSS scores of the contralesional and bilateral sti-mulation groups were then significantly better than those of the other two groups. The sub-item and total VDS scores of all 4 groups had decreased significantly, but the average score of the bilateral stimulation group was significantly lower than the control group′s average. Ipsilesional stimulation significantly improved the VDS sub-item scores for the triggering of pharyngeal swallowing, laryngeal elevation, and pharyngeal transit time compared with the control group. In the contralesional stimulation group the average total score and the VDS sub-item scores for apraxia, premature bolus loss, oral transit times, the triggering of pharyngeal swallowing, vallecular residue, laryngeal elevation, coating on the pharyngeal wall, and pharyngeal transit time were significantly lower than those of the control group, on average. After the treatment the latencies of BAEP waves I, III and V and the I-III, III-V and I-V interpeak intervals had decreased significantly in all four groups, but the average latencies and intervals of the bilateral and contralesional groups were significantly shorter than those of the control group. The latencies and intervals of the bilateral stimulation group were then significantly shorter than those in the ipsilesional stimulation group on average. The average latency of wave V in the bilateral stimulation group (6.53±0.73ms) was significantly shorter than that in the contralesional stimulation group after the treatment.Conclusion:Bilateral rTMS over the swallowing motor cortex combined with conventional dysphagia training can significantly improve the swallowing of dysphagic stroke survivors.

Objective:To investigate the effects of transaxillary endoscopic and traditional open radical thyroidectomy on the levels of inflammatory factors in patients with thyroid cancer.Methods:The clinical data of 102 thyroid cancer patients underwent radical thyroidectomy from October 2019 to October 2021 in Xinjiang Medical University Hospital of Chinese Medicine were retrospectively analyzed. Among them, 50 cases underwent transaxillary approach endoscopic radical thyroidectomy (study group), and 52 cases underwent open radical thyroidectomy (control group). The operation related indexes were compared between two groups, including operation time, intraoperative blood loss, postoperative drainage, lymph node clearance and hospital stay; the pain scores 1, 3 and 7 d after operation were recorded; the levels of interleukin-6 (IL-6), interleukin-10 (IL-10), galectin-3 (Gal-3) and tumor necrosis factor-α (TNF-α) before operation and 1 d after operation were measured by enzyme-linked immunosorbent assay; the postoperative complications were recorded, including hoarseness, limb numbness, cough after drinking water and hypocalcemia; and the cosmetic satisfaction was followed up 3 months after discharge, and the recurrence was observed by CT 6 months after discharge.Results:The operation time in study group was significantly longer than that in control group: (88.69 ± 15.16) min vs. (61.47 ± 15.48) min, while the intraoperative blood loss, postoperative drainage and hospital stay were significantly lower in control group: (51.21 ± 10.06) ml vs. (85.46 ± 11.37) ml, (98.29 ± 30.61) ml vs. (117.47 ± 30.25) ml and (5.35 ± 0.54) d vs. (7.72 ± 0.61) d, and there were statistical differences ( P<0.01); there was no statistical difference in lymph node clearance between two groups ( P>0.05). The pain score 1 and 3 d after operation in study group was significantly lower than that in control group: (5.13 ± 1.07) scores vs. (7.87 ± 1.46) scores and (4.22 ± 1.35) scores vs. (6.42 ± 1.28) scores, and there were statistical differences ( P<0.05); there was no statistical difference in pain score 7 d after operation between two groups ( P>0.05). There were no statistical differences in IL-6, IL-10, TNF-α and Gal-3 between two groups ( P>0.05); the IL-6, IL-10, TNF-α and Gal-3 1 d after operation in study group were significantly lower than those in control group: (26.27 ± 3.14) ng/L vs. (29.22 ± 4.52) ng/L, (7.54 ± 2.31) ng/L vs. (10.92 ± 2.54) ng/L, (14.98 ± 3.76) μg/L vs. (23.65 ± 2.46) μg/L and (3.54 ± 0.48) μg/L vs. (4.48 ± 0.63) μg/L, and there were statistical differences ( P<0.01). There was no statistical difference in the incidence of total complications between two groups ( χ2 = 1.73, P>0.05). The total satisfaction rate in study group was significantly higher than that in control group: 94.0% (47/50) vs. 78.8% (41/52), and there was statistical difference ( χ2 = 4.94, P<0.05). The patients were followed up for 6 months after discharge, and there was no recurrence. Conclusions:The transaxillary approach endoscopic radical thyroidectomy can reduce intraoperative blood loss, length of stay, postoperative drainage, postoperative pain, and to some extent inhibit inflammatory response. It can improve the postoperative cosmetic satisfaction, reduce the incidence of postoperative complications, and does not increase the recurrence rate

Objective:To explore the safety and early prognosis of robot assisted living donor kidney transplantation(KT)and plot the learning curve of mastering the operation.Methods:From July 2020 to March 2021, 30 cases of living robot assisted KT were completed.The follow-up period was 3 months.Cumulative sum analysis was performed for plotting the learning curve.According to the learning curve, they were divided into two groups of practice period(the first 17 cases)and proficiency period(the last 13 cases). Time of each operative stage and early prognosis were compared.Kidney function and perioperative complications of two groups were compared for evaluating the safety and effectiveness of robot assisted KT.Results:The average operative duration was (221.4±36.1)min.No intestinal obstruction, delayed graft function, urinary leakage and incision infection occurred during perioperative period.The average anal exhaust time was(1.9±0.2)days.During follow-ups, both pulmonary infection(2 cases)and acute rejection(1 case)improved after treatment.According to the learning curve, venous anastomosis(10 cases), arterial anastomosis(12 cases), warm ischemic time(12 cases)and ureteral anastomosis(17 cases)should be performed for reaching a proficiency level.An average of 15 operations was required for achieving proficiency throughout operations.Significant inter-group differences existed in operative duration [(235.5±31.6)vs(203.0±34.3)min, P=0.012] and warm ischemic time [(63.7±24.9)vs(47.0±11.3)min, P=0.033]. At some postoperative timepoints, creatinine of proficiency group was lower than that of practice group, such as Day 7 post-operation [(192.7±135.2)vs(107.8±27.9)μmol/L, P=0.022] and Day 30 post-operation [(147.8±46.3)vs(112.3±28.0)μmol/L, P=0.021]. However, no significant difference existed in estimated glomerular filtration rate at Day 7 post-operation [(56.1±34.1)ml/(min·1.73m 2)vs(72.0±18.5)ml/(min·1.73m 2), P=0.14] and Day 30 post-operation [(56.2±18.9)ml/(min·1.73m 2)vs(68.7±15.3)ml/(min·1.73m 2), P=0.14]. Conclusions:Robot assisted KT is both safe and feasible.And the learning curve requires 17 cases for reaching a proficiency level.

【Objective】 To analyze the related factors affecting perioperative blood transfusionin patients undergoing totalhysterectomy, explorethe effective measures to reduce allogeneic blood transfusion and provide data for the establishment of clinical blood transfusion single-disease evaluation index of total hysterectomy. 【Methods】 747 cases of total hysterectomy from three grade-A tertiary general hospitals and onematernal and child health care hospitalin Dalian wereselected, and divided into transfusion group(n=69)and non-transfusion(n=678). Detailed information was collected and analyzed, including patient demographics, operation information, blood routine before operation, postoperative recovery and transfusion volume. 【Results】 9.2%(69/747)of total hysterectomy patients received blood transfusion, with per capita red blood usageof(0.4±2.1)U. The age, operative time, volume of intra-operationbleeding, pre-operationhemoglobin(Hb) level, length ofhospital stay, types and days of antibiotics use between transfusion group and non-transfusion groupwere (49.7±9.1)vs(53±9.5)years old, (182.7±83.5)vs(119.5±64.8)min, (603±650)vs(160±173)mL, (96±26)vs(124±18)g/L, (9.3±4.8)vs(7.3±3.9)days, (2.2±1.1)vs(1.6±0.7)kinds, (6.0±3.9)vs (4.4±2.2)days, respectively, showing significant differences(P<0.05). Transfusion volumewas associated with volume of intra-operation bleeding (r=0.004), operative time (r=0.002) and Hb level of pre-operation(r=-0.022). 【Conclusion】 Blood management of patients undergoingtotal hysterectomy should be strengthened to reduce the incidence of allogeneic blood transfusion and improve patient outcomes by raising the pre-operation Hb level, shortening the operative time and reducing the volume of intra-operation bleeding.

Objective:To compare the efficacy between acupuncture and acupuncture with infrared thermography-guided Chinese massage (Tuina) in treatment of children with Bell′s palsy (BP).Methods:Seventy two children with BP admitted to the Rehabilitation Department of Beijing Children′s Hospital from October 2019 to April 2020 were randomly assigned into two groups: 35 cases were treated with acupuncture alone (acupuncture group) and 37 cases received acupuncture combined with Tuina for treatment (combination group). In combination group, the temperature of forehead, cheek and mandible areas was examined by infrared thermography before each course. Compared healthy side if the temperature on the affected side was lower, higher or the same, rubbing method, tapping method and one-finger meditation push method of Tuina was applied, afterwards the acupuncture treatment was given as in the acupuncture group. Patients in both groups were treated once a day with 5 days for a course and a total of 3 courses. The patients were assessed with House-Brackmann (H-B) facial nerve function evaluation scale and Portmann simple score scale before and after each course of treatment.Results:The H-B classification of the two groups of children at the end of the third course of treatment was significantly better than that before treatment (χ2=31.01, 56.41; P<0.01). There was no significant difference in H-B grading between the two groups before treatment, after the first and second course (χ2=0.58, 8.49, 6.79; P>0.05). After the third course of treatment, the H-B grading assessment of the combination group was significant better than that of the acupuncture group (χ2=10.03, P<0.05). The Portmann scores of the two groups were improved after each course of treatment ( F=9.68, 22.54; P<0.01); however, the facial nerve function of combination group was improved more significantly than that of acupuncture group [(13.97±4.58) vs.(10.97±5.40), t=2.55, P=0.01]. The total effective rate of combination group was higher than that of acupuncture group [51.35% (19/37) vs. 20.00% (7/35), χ2=6.79, P<0.05]. There was a significant difference in the application frequency of three Tuina methods among the forehead, cheek and mandibular areas in the first course and the third course (χ2=21.23, 13.33; P<0.05). In the same area (forehead, cheek and mandible) there was a significant difference in the application frequency of three massage techniques among the three courses of treatment (χ2=31.26, 21.35, P<0.01). Conclusion:With the guidance of infrared thermal imaging, individualized Chinese massage (Tuina) combined with acupuncture treatment is more effective in treatment of children with Bell′s palsy than using acupuncture alone.