Objective: To develop the Family-School-Community Cooperation Dilemma Scale for Nutritional Education in Primary Schools Students, and to determine its reliability and validity, in order to provide a basis for developing targeted strategies to promote family-school-community cooperation in the area of nutritional education. Methods: Based on overlapping spheres of influence theory, the initial scale was developed through a qualitative and literature review, discussion with Delphi experts and a pilot survey from July 2022 to July 2023. From July to September 2023, a total of 125 primary school parents, 118 primary school teachers and 113 community personnel were selected from six cities in Jiangsu Province by convenient sampling methods, who were investigated to test the reliability and validity of the scale and to develop a formal scale. Results: The final Family-School-Community Cooperation Dilemma Scale for Nutritional Education in Primary School students consisted of 3 dimensions and 19 items. The exploratory analysis extracted three metric factors, with a contribution ratio of 69.07% to the accumulated variance. The mean scale component effectiveness was 0.94, and the coefficient of association between the respective dimensions and the scale ranged from 0.80 to 0.91.The overall Cronbach α coefficient for the scale was 0.95, the folded half reliability was 0.87, and the retest reliability was 0.98. Conclusion The Family-School-Community Cooperation Dilemma Scale for Nutritional Education in Primary School Students has good reliability and validity, and can be used to measure the degree of the family-school-community cooperation dilemma regarding nutritional education in primary school students.

The regulatory role of pericoronary adipose tissue(PC AT)in cardiovascular diseases is of paramount im-portance.PCAT exerts extensive pathophysiological effects on the cardiovascular system by secreting various bioactive substances,such as adipokines and cytokines.Currently,the attenuation value of PCAT can be detected via coronary computed tomography angiography(CCTA),a method that not only reflects the level of vascular inflammation but also holds significant clinical value in the detection and prognostic assessment of coronary heart disease plaques.Therefore,this article reviews the pathophysiological mechanisms of PCAT and its clinical significance in coronary heart disease.

Objective:To retrospectively analyze the treatment status of tyrosine kinase inhibitors (TKI) in newly diagnosed patients with chronic myeloid leukemia (CML) in China.Methods:Data of chronic phase (CP) and accelerated phase (AP) CML patients diagnosed from January 2006 to December 2022 from 77 centers, ≥18 years old, and receiving initial imatinib, nilotinib, dasatinib or flumatinib-therapy within 6 months after diagnosis in China with complete data were retrospectively interrogated. The choice of initial TKI, current TKI medications, treatment switch and reasons, treatment responses and outcomes as well as the variables associated with them were analyzed.Results:6 893 patients in CP ( n=6 453, 93.6%) or AP ( n=440, 6.4%) receiving initial imatinib ( n=4 906, 71.2%), nilotinib ( n=1 157, 16.8%), dasatinib ( n=298, 4.3%) or flumatinib ( n=532, 7.2%) -therapy. With the median follow-up of 43 ( IQR 22-75) months, 1 581 (22.9%) patients switched TKI due to resistance ( n=1 055, 15.3%), intolerance ( n=248, 3.6%), pursuit of better efficacy ( n=168, 2.4%), economic or other reasons ( n=110, 1.6%). The frequency of switching TKI in AP patients was significantly-higher than that in CP patients (44.1% vs 21.5%, P<0.001), and more AP patients switched TKI due to resistance than CP patients (75.3% vs 66.1%, P=0.011). Multi-variable analyses showed that male, lower HGB concentration and ELTS intermediate/high-risk cohort were associated with lower cytogenetic and molecular responses rate and poor outcomes in CP patients; higher WBC count and initial the second-generation TKI treatment, the higher response rates; Ph + ACA at diagnosis, poor PFS. However, Sokal intermediate/high-risk cohort was only significantly-associated with lower CCyR and MMR rates and the poor PFS. Lower HGB concentration and larger spleen size were significantly-associated with the lower cytogenetic and molecular response rates in AP patients; initial the second-generation TKI treatment, the higher treatment response rates; lower PLT count, higher blasts and Ph + ACA, poorer TFS; Ph + ACA, poorer OS. Conclusion:At present, the vast majority of newly-diagnosed CML-CP or AP patients could benefit from TKI treatment in the long term with the good treatment responses and survival outcomes.

Objective To analyze the influencing factors of self-management ability of coronary heart disease patients after percutaneous coronary intervention (PCI) and construct a nomogram model. Methods A total of 247 CHD patients who underwent PCI were selected as the research subjects, and all of them were evaluated by Coronary Heart Disease Self-management Scale (CSMS). Multivariate Logistic regression analysis was used to screen out the independent influencing factors of self-management ability of CHD patientsafter PCI, and R software was used to construct a nomogram model. The discrimination, calibration, and goodness-of-fit of the nomogram model were evaluated by receiver operating characteristic (ROC) curve, calibration curve, and Hosmer-Lemeshow goodness-of-fit test. Results The average CSMS score of 247 patients was (86.79±9.22), and these patients were divided into low-score group(89 patients) and high-score group (158 patients)based on the critical value of 86.79 points. There were significant differences in age, education level, monthly per capita family income, and self-efficacy between the low-score group and the high-score group (P < 0.05). Multivariate Logistic regression analysis showed that age, education level, monthly per capita family income, and self-efficacy were independent influencing factors of self-management ability of CHD patients after PCI (P < 0.05). The nomogram model constructed based on the four influencing factors found that age >70 years increased the weight by 86.2 points, education level below high school increased the weight by 87.4 points, monthly per capita family income < 3 500 yuan increased the weight by 82.3 points, and low self-efficacy increased the weight by 99.6 points. The results of ROC curve analysis showed that the area under the curve of the nomogram model for predicting self-management ability ofCHD patients after PCI was 0.842 (95%CI, 0.794 to 0.890). The slope of the calibration curve was close to 1, and the results of goodness-of-fit test was as follows: χ²=10.226, P=0.233. Conclusion Age, education level, monthly per capita family income, and self-efficacy are influencing factors of self-management ability of CHD patients after PCI, and the nomogram model constructed based on these factors has high predictive value for self-management ability.

OBJECTIVE To evaluate the economics of utidelone combined with capecitabine compared with capecitabine in the second-line treatment of metastatic breast cancer from the perspective of Chinese health-care system. METHODS A partitioned survival model was established using clinical trial data and relevant literature data, with the cycle of 3 weeks and the time horizon of 15 years. Cost and utility data were discounted using a discount rate of 5%. The model output was the incremental cost-effectiveness ratio(ICER), and the willingness-to-pay threshold(WTP) was set to 1-3 times per capita gross domestic product(GDP) in China in 2021(80 976 yuan/QALY-242 928 yuan/QALY). One-way sensitivity analyses and probabilistic sensitivity analyses were performed to evaluate the stability of model results when the model parameters were changed. RESULTS The results of base-case analysis showed that utidelone combined with capecitabine was a high-cost and high-health benefit regimen, and the ICER was 393 949.83 yuan/QALY. One-way sensitivity analyses showed that the price of utidelone was the most influential factor of the ICER, and the probabilistic sensitivity analyses showed that the model results were robustness. CONCLUSION Utidelone combined with capecitabine has no economic advantage compared with capecitabine alone in the second-line treatment of metastatic breast cancer, but in areas with per capita GDP of more than 131 316 yuan, utidelone combined with capecitabine can be considered the cost-effective regimen.

OBJECTIVE To study the metabolites of four diterpenoids of Euphorbia fischeriana in liver microsomes of rats and to investigate its metabolic regularity. METHODS In vitro incubation system of liver microsomes of rats was built. The jolkinolide A，jolkinolide B ，17-hydroxyl jolkinolide A and 17-hydroxyl jolkinolide B were added into incubation system of liver microsomes in rats activated by reduced nicotinamide adenine dinucleotide phosphate ，incubated at 37 ℃ for 30 min，and then terminated the reaction with acetonitrile. Taking the negative group （adding acetonitrile firstly and then starting incubation for 30 min）as the reference，the ultra-high performance liquid chromatography-quadrupole time-of-flight mass spectrometry was used ；Anaylyst®TF 1.7.1、PeakView® 2.2，MetabolitePilot 1.5 and MasterView 1.2 software were used to speculate and identify the fragmentation law of mass spectrometry and metabolites. RESULTS Four diterpenoids were easy to lose neutral fragments such as H 2O and CO in secondary mass spectrometry. Jolkinolide A and 17-hydroxyl jolkinolide A showed similar metabolism pathway ，including dihydroxylation，dehydrogenation，and monohydroxylation ；six and five metabolites were identified respectively. Jolkinolide B and 17-hydroxyl jolkinolide B showed similar metabolism pathway ，including monohydroxylation ，hydration and isomerization. Five metabolites were identified. CONCLUSIONS Both jolkinolide A and 17-hydroxyl jolkinolide A produce the metabolites of hydroxylation and dehydrogenation in liver microsomes of rats ；both jolkinolide B and 17-hydroxyl jolkinolide B produce the metabolites of hydroxylation ，hydration and isomerization in liver microsomes of rats. The metabolites of four diterpenoids are phase Ⅰ metabolites.

Objective:To explore the status quo of self-management ability in young and middle-aged patients with gout and analyze its influencing factors.Methods:Totally 225 patients with gout admitted in the Department of Rheumatology and the Department of Endocrinology at a ClassⅢ Grade A hospital in Jilin Province from September 2020 to March 2021 were selected by convenient sampling and investigated with the general information questionnaire, Gout Patient Self-Management Assessment Scale, and Medical Coping Modes Questionnaire.Results:The total score of self-management ability in young and middle-aged patients with gout was (127.29±22.42) , including (41.15±7.38) in disease treatment management, (37.41±7.20) in diet management, (27.42±5.62) in lifestyle management, and (21.31±5.06) in psychosocial management. The results of multiple linear regression analysis showed that the education level, course of illness, smoking, facing and avoiding coping styles were the influencing factors of the self-management ability of gout patients ( P<0.05) . Conclusions:The self-management ability of young and middle-aged gout patients is the best in disease treatment management and the worst in psychosocial management in all dimensions, but the overall level is at a medium level and needs to be improved. Clinical medical staff should take targeted health education strategies based on its influencing factors to improve the self-management level of disease in young and middle-aged gout patients.

Objective:To explore the application effect of SBAR communication mode based on early warning hierarchical management in emergency observation room.Methods:Formulating the handover program of SBAR communication mode based on the early warning hierarchical management, systematically training the nurses of the observation room and put into effect.The 455 patients transferred by 18 nurses in the observation room from November to December 2018 were listed as the control group, and the traditional SBAR communication mode was implemented for the handover.A total of 443 patients with nurse handover from November to December 2019 were included in the observation group, and the SBAR communication mode based on early warning hierarchical management was implemented. The incidence of adverse nursing events, quality of nursing handover, doctors' and nurses' satisfaction with the handover were compared between the two groups.Results:The incidence of adverse events was 1.81%(8/443) in the observation group and 7.91%(36/455) in the control group, the difference between the two groups was statistically significant (χ 2 value was 17.96, P < 0.05).In the observation group, the nursing handover quality and nurse's knowledge of the patients’ condition were (91.37±2.73) points and (96.7%,58/60) respectively, while those in the control group were (89.07±2.76) points and (81.7%, 49/60).The difference between the two groups was statistically significant ( t value was -2.38, χ 2 value was 6.99,all P<0.05).The satisfaction of doctors and nurses on nursing handover was 95.0%(57/60) and 95.0%(57/60)in the observation group respectively, and that in the control group was 83.3%(50/60) and 81.7%(49/60) respectively.The difference between the two groups was statistically significant (χ 2 values were 4.23, 5.18, P < 0.05). Conclusions:SBAR communication mode based on early warning classification can significantly improve the early warning ability of nurses in emergency observation room during the shift, reduce the occurrence of adverse nursing events, improve the quality of nursing shift, and improve the satisfaction of doctors and nurses.

Objective:To develop a geriatric nursing core literacy evaluation scale and to test its validity and reliability.Methods:The scale item pool was constructed by referring to relevant literatures and expert consultation method was used to form initial scale. A preliminary investigation was conducted among 40 nurses to form the formal scale, and then 252 nurses were selected to test the validity and reliability of the formal scale.Results:The formal scale consisted of four dimensions and 37 items. The Cronbach α coefficient of the formal scale was 0.980, the content validity index was 0.912, exploratory factor analysis identified 4 principal factors (knowledge geriatric nursing core literacy, skill geriatric nursing core literacy, cognitive geriatric nursing core literacy, belief geriatric nursing core literacy) and explained 73.135% of the total variance.Conclusion:The geriatric nursing core literacy evaluation scale has good reliability and validity, which can be used to evaluate the geriatric nursing core literacy of nursing staffs.

Objective:To explore disorienting dilemmas during postgraduate study period experienced by postgraduates with master of nursing specialist who participated in the national postgraduate entrance examination and provide a basis for teaching reform based on transformative learning theory.Methods:Using the purposive sampling method and the maximum difference method, 23 full-time masters of nursing specialist who participated in the national postgraduate entrance examination from 3 universities of Jiangsu Province were selected as the research objects from March to June 2019. The descriptive qualitative research method was used to conduct semi-structured interviews, and the traditional content analysis method was used to analyze the interview data.Results:Four themes of disorienting dilemmas of masters of nursing specialist were extracted: the expected hypothesis of challenges of new environment in course learning, a gap between scientific research ability and training target, adjustment of self-positioning in clinical practice and insufficient preparations for graduation of master of nursing specialist.Conclusions:Master of nursing specialist have disorienting dilemmas in course study, scientific research, clinical practice and graduation preparation, and nursing educators can use this as a trigger point to carry out teaching reform based on transformative learning theory.