Objective To explore the pioneering symptoms of the gastrointestinal symptom cluster and their influencing factors in gastric cancer patients with chemotherapy.Methods Based on the hospital's management system for scientific research data,463 gastric cancer patients with chemothera-py were surveyed through multicenter collaboration by the corresponding module of the MD Anderson Symptom Inventory(MDASI),the Chinese Medicine Constitution Classification and Identification Standard,and the Chinese Medicine SyndromeIdentification Standard for Gastric Cancer.IBM SPSS Statistic 22.0 and IBM SPSS Modeler 18.0 were used for data analysis.Results The first occurrence of dry mouth in the gastrointestinal symptom cluster of gastric cancer patients with chemotherapy was(22.99±10.70)hours after chemotherapy.The support,confidence,and lift for the association be-tween dry mouth and decreased appetite were 62.2％,94.8％and 1.52,respectively;for dry mouth and nausea,the numerical values were 62.2％,89.6％and 1.44;for dry mouth and vomiting,the numerical values were 62.2％,79.5％and 1.28.The results of one-way ANOVA and multivariate linear regression analysis showed that alcohol consumption,syndrome of stomach heat injuring yin,and phlegm-dampness constitution were independent influencing factors for dry mouth in gastric cancer patients with chemotherapy(P＜0.05).Conclusion Dry mouth,as a pioneering symptom of the gastroin-testinal symptom cluster,is of great significance in clinical assessment and management.Improved assessment of dry mouth can provide a basis for the construction of subsequent risk prediction model,the formulation of targeted interventions,and the enhancement of symptom management efficiency.

Objective To explore the application of Mini-CEX oriented by nurses'core competencies in the clinical teaching of intern nursing students.Methods A total of 50 students,interning in the First Affiliated Hospital of Kunming Medical University from January 1,2023 to April 30,2024,were randomly divided into experimental group and control group,with 25 students in each group.The control group was taught by traditional clinical teaching methods,and the experimental group by Mini-CEX.The data indicators of the two groups of intern nursing students were analyzed and compared at entry into and exit from the department,respectively.Results The scores of the two groups were higher than those at entry into the department(P<0.05),and the intern nursing students in the experimental group had excellent scores in nursing consultation,nursing examination,nursing diagnosis,nursing measures,humanistic care,organizational effectiveness,health consultation,and overall evaluation,and the scores were higher than those of the control group(P<0.05).The improvement in all the scores was also better than that of the control group(P<0.05).Conclusion Mini-CEX,which is oriented to the nurse'core competencies of nurses,can improve the clinical nursing abilities of intern nursing students and enhance the cultivation effect of clinical practice skills.

ObjectiveTo investigate the characteristics of injury deaths and its disease burden in Taizhou City from 2009 to 2022, and to provide a basis for the prevention and control of injury. MethodsBased on the injury death surveillance data of Taizhou City from 2009 to 2022, the age-specific and sex-specific mortality rates, as well as the standardized mortality rates after adjusting China’s standardized population age of residents in Taizhou City were calculated. The crude mortality rate, standardized mortality rate, average years of life lost(AYLL), potential years of life lost (PYLL) and potential years of life lost rate (PYLLR) were calculated using Excel 2013 software. Joinpoint 4.2 software was used to estimate the annual percentage change (APC) and analyze the trends of injury mortality and PYLLR from 2009 to 2022. ResultsFrom 2009 to 2022, the standardized mortality rate of injuries in Taizhou City showed a decreasing trend (APC=-4.876%, P<0.001), with a mortality rate of 64.38/100 000 and a standardized mortality rate of 66.68/100 000. There was a statistically significant difference in injury deaths by genders (χ²=7 520.153, P<0.001). From 2009 to 2022, the PYLL and AYLL caused by injuries in Taizhou City were 587 518 person years and 21.91 years, respectively, with a PYLLR of 7.72%. The PYLLR of injuries showed a decreasing trend (APC=-7.454%, P<0.001), in addition, the PYLLR in urban(APC=-7.123%), rural areas (APC=-10.193%), males (APC=-7.595%) and females (APC=-7.046%) all showed a decreasing trend, all differences were statistically significant(all P<0.001). The top five causes of injury deaths leading to PYLL were traffic accident, drowning, accidental fall, suicide and accidental poisoning. ConclusionIn the last decade, injury has been a major cause leading to premature death among residents in Taizhou, with a higher mortality rate in males than that in females, and different injury characteristics caused by different types of injuries. It is necessary to take targeted injury prevention and intervention measures for different key population groups to effectively reduce the disease burden caused by injury deaths.

Objective To investigate the effect of KH-type splicing regulatory protein(KHSRP)on the malignant biological behavior of lung adenocarcinoma(LUAD)by targeting the Janus kinase 1(JAK1)/signal transducer and activator of transcription 3(STAT3)signaling axis.Methods Clinical data were collected for 64 patients with LUAD,diagnosed at Huaihe Hospital from January 2017 to December 2018.Expression levels of KHSRP were detected in LUAD tissues and adjacent tissues by immunohistochemical staining.KHSRP gene expression was also detected in LUAD cell lines(SPC-A1,H1975,CL1-5,PC-9,Calu-3,H446)and normal human bronchial epithelial cells using quantitative reverse transcription-polymerase chain reaction.KHSRP expression in SPC-A1,H1975,PC-9,and Calu-3 cells was manipulated by lentivirus transfection.The effects of KHSRP on the proliferation,migration,and invasion of LUAD cells were detected by Cell Counting Kit-8 and Transwell assays.The effects of KHSRP overexpression and knockdown were also investigated in a mouse xenograft tumor model,and JAK/STAT signaling pathway proteins were detected by Western blot.Rescue experiments were conducted to verify if KHSRP promoted the malignant progression of LUAD cells by regulating the JAK1/STAT3 signaling pathway.Results KHSRP expression was significantly higher in LUAD tissues compared with adjacent tissues(P＜0.05).Overexpression of KHSRP significantly promoted the proliferation,migration,and invasion of LUAD cells in vitro(P＜0.05).KHSRP also promoted LUAD cell xenograft tumor growth and lung nodule metastasis in nude mice in vivo(P＜0.01).KHSRP knockdown significantly decreased the levels of JAK1,phospho-JAK1,and STAT3 in the JAK/STAT signaling pathway,while the situation was reversed following KHSRP overexpression(P＜0.05).Rescue experiments showed that KHSRP reversed the inhibitory effect of knockdown(P＜0.05).Conclusions KHSRP targets the JAK1/STAT3 signaling pathway and acts as an oncogene in LUAD.

Objective:To explore the clinical efficacy of anterolateral thigh perforator flap (ALTPF) in treatment of extensive wound of Degree IV burns in limbs.Methods:A retrospective analysis was conducted on 9 patients who had extensive wound of Degree IV burns in limbs caused by stove burns admitted to Department of Burns and Plastic Surgery, the 988th Hospital of the Joint Logistics Support Force of the Chinese PLA between January 2017 and January 2024. Among the patients, there were 8 males and 1 female, aged between 36 and 63 years. Three patients had the wound from anterior leg to dorsal foot, 3 from leg down to ankle, 1 from forearm to hand and 2 from arm to forearm. Area of burns ranged from 20 cm × 15 cm to 30 cm × 25 cm, and all patients were treated by free ALTPF. According to whether the main artery at the recipient site was feasible for direct anastomosis with the vessels carried in flap, 4 patients were treated by bilateral parallel ALTPFs, and 5 were treated by unilateral ultra-long internally supercharged ALTPF. A total of 13 ALTPFs were harvested, with individual flap size at 20 cm × 8 cm to 46 cm × 12 cm. Donor sites were directly sutured. Time for flap harvesting, flap survival and wound healing time were records. Scheduled postoperative follow-up was conducted at outpatient clinic and via telephone interviews to evaluate functional recovery. Follow-up assessments included evaluation of flap condition, two-point discrimination (TPD), recovery of joint function at recipient sites, flap appearance and donor site recovery.Results:The time for flap harvest was 1.0 to 4.5 hours. All 13 ALTPFs successfully survived. The time from surgery to healing of recipient sites was 18 to 72 days, and all donor sites healed. Over the postoperative follow-up that lasted for 6 to 34 months, the recipient sites had found with good cosmetic outcomes, without osteomyelitis or deep tissue infection. Four ALTPFs in 2 patients were found swelling, which were revised at 6 months after surgery. Four ALTPFs in other 2 patients had pigment deposition at edges. One ALTPF was scalded, which healed after dressing changes but left with patchy scars. The remaining ALTPFs were soft, elastic, free from pain and well-perfused, with regained protective sensation at S 3. However, all of the ALTPFs failed to detect TPD. Six patients with lower limb injuries were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) ankle hindfoot scoring system: 2 patients were rated as excellent and 4 were rated as good. Three patients with upper limb injuries were evaluated using Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association: 1 patient was rated as excellent and 2 were rated as good. Only linear scars left at the 13 donor sites, with normal blood supply to the distal limbs, and without restrictions in range of motion of knee joints nor muscle strength of quadriceps. Conclusion:The ALTPF offers advantages such as anatomical consistency, reliable blood supply and flexible combination in treatment of extensive wound of Degree Ⅳ burns in limbs. It is an ideal surgical procedure for treatment of large soft tissue defects of extremities.

3D printing technology customized medical devices can accurately adapt to the complex anatomical structure of the human body, and have become a new meaning to promote the development of precision medicine. In order to ensure the safety and effectiveness of the clinical use of 3D printed customized medical devices and standardize the management process of such products, a tertiary hospital had started the file-record management of 3D printed customized medical devices since March 2021, covering access approval management, production verification, surgical process management and postoperative traceability management. This practice had achieved standardized management of 3D printed customized medical devices and achieved good results. The 3D printed bone fixation fusion used by the hospital was officially approved as a medical device product registration certificate in March 2023; 109 orthopedic patients recorded the use of 3D printed custom medical devices in 2023, with a significant increase compared to 54 patients in 2022. This practice could provide references for other hospitals to carry out standardized management of the use of customized medical devices. In the future, hospital should further balance regulation and innovation, promote multi-party collaboration, strengthen data integration, ensure data security, and enhance the level of refined management of medical devices.

Objective To investigate the effect of KH-type splicing regulatory protein(KHSRP)on the malignant biological behavior of lung adenocarcinoma(LUAD)by targeting the Janus kinase 1(JAK1)/signal transducer and activator of transcription 3(STAT3)signaling axis.Methods Clinical data were collected for 64 patients with LUAD,diagnosed at Huaihe Hospital from January 2017 to December 2018.Expression levels of KHSRP were detected in LUAD tissues and adjacent tissues by immunohistochemical staining.KHSRP gene expression was also detected in LUAD cell lines(SPC-A1,H1975,CL1-5,PC-9,Calu-3,H446)and normal human bronchial epithelial cells using quantitative reverse transcription-polymerase chain reaction.KHSRP expression in SPC-A1,H1975,PC-9,and Calu-3 cells was manipulated by lentivirus transfection.The effects of KHSRP on the proliferation,migration,and invasion of LUAD cells were detected by Cell Counting Kit-8 and Transwell assays.The effects of KHSRP overexpression and knockdown were also investigated in a mouse xenograft tumor model,and JAK/STAT signaling pathway proteins were detected by Western blot.Rescue experiments were conducted to verify if KHSRP promoted the malignant progression of LUAD cells by regulating the JAK1/STAT3 signaling pathway.Results KHSRP expression was significantly higher in LUAD tissues compared with adjacent tissues(P＜0.05).Overexpression of KHSRP significantly promoted the proliferation,migration,and invasion of LUAD cells in vitro(P＜0.05).KHSRP also promoted LUAD cell xenograft tumor growth and lung nodule metastasis in nude mice in vivo(P＜0.01).KHSRP knockdown significantly decreased the levels of JAK1,phospho-JAK1,and STAT3 in the JAK/STAT signaling pathway,while the situation was reversed following KHSRP overexpression(P＜0.05).Rescue experiments showed that KHSRP reversed the inhibitory effect of knockdown(P＜0.05).Conclusions KHSRP targets the JAK1/STAT3 signaling pathway and acts as an oncogene in LUAD.

Objective:To explore the clinical efficacy of anterolateral thigh perforator flap (ALTPF) in treatment of extensive wound of Degree IV burns in limbs.Methods:A retrospective analysis was conducted on 9 patients who had extensive wound of Degree IV burns in limbs caused by stove burns admitted to Department of Burns and Plastic Surgery, the 988th Hospital of the Joint Logistics Support Force of the Chinese PLA between January 2017 and January 2024. Among the patients, there were 8 males and 1 female, aged between 36 and 63 years. Three patients had the wound from anterior leg to dorsal foot, 3 from leg down to ankle, 1 from forearm to hand and 2 from arm to forearm. Area of burns ranged from 20 cm × 15 cm to 30 cm × 25 cm, and all patients were treated by free ALTPF. According to whether the main artery at the recipient site was feasible for direct anastomosis with the vessels carried in flap, 4 patients were treated by bilateral parallel ALTPFs, and 5 were treated by unilateral ultra-long internally supercharged ALTPF. A total of 13 ALTPFs were harvested, with individual flap size at 20 cm × 8 cm to 46 cm × 12 cm. Donor sites were directly sutured. Time for flap harvesting, flap survival and wound healing time were records. Scheduled postoperative follow-up was conducted at outpatient clinic and via telephone interviews to evaluate functional recovery. Follow-up assessments included evaluation of flap condition, two-point discrimination (TPD), recovery of joint function at recipient sites, flap appearance and donor site recovery.Results:The time for flap harvest was 1.0 to 4.5 hours. All 13 ALTPFs successfully survived. The time from surgery to healing of recipient sites was 18 to 72 days, and all donor sites healed. Over the postoperative follow-up that lasted for 6 to 34 months, the recipient sites had found with good cosmetic outcomes, without osteomyelitis or deep tissue infection. Four ALTPFs in 2 patients were found swelling, which were revised at 6 months after surgery. Four ALTPFs in other 2 patients had pigment deposition at edges. One ALTPF was scalded, which healed after dressing changes but left with patchy scars. The remaining ALTPFs were soft, elastic, free from pain and well-perfused, with regained protective sensation at S 3. However, all of the ALTPFs failed to detect TPD. Six patients with lower limb injuries were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) ankle hindfoot scoring system: 2 patients were rated as excellent and 4 were rated as good. Three patients with upper limb injuries were evaluated using Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association: 1 patient was rated as excellent and 2 were rated as good. Only linear scars left at the 13 donor sites, with normal blood supply to the distal limbs, and without restrictions in range of motion of knee joints nor muscle strength of quadriceps. Conclusion:The ALTPF offers advantages such as anatomical consistency, reliable blood supply and flexible combination in treatment of extensive wound of Degree Ⅳ burns in limbs. It is an ideal surgical procedure for treatment of large soft tissue defects of extremities.

3D printing technology customized medical devices can accurately adapt to the complex anatomical structure of the human body, and have become a new meaning to promote the development of precision medicine. In order to ensure the safety and effectiveness of the clinical use of 3D printed customized medical devices and standardize the management process of such products, a tertiary hospital had started the file-record management of 3D printed customized medical devices since March 2021, covering access approval management, production verification, surgical process management and postoperative traceability management. This practice had achieved standardized management of 3D printed customized medical devices and achieved good results. The 3D printed bone fixation fusion used by the hospital was officially approved as a medical device product registration certificate in March 2023; 109 orthopedic patients recorded the use of 3D printed custom medical devices in 2023, with a significant increase compared to 54 patients in 2022. This practice could provide references for other hospitals to carry out standardized management of the use of customized medical devices. In the future, hospital should further balance regulation and innovation, promote multi-party collaboration, strengthen data integration, ensure data security, and enhance the level of refined management of medical devices.

Objectives:To retrieve,evaluate and summarize the contemporary evidence of strategies for weaning from extracorporeal membrane oxygenation(ECMO)of adult patients,and to provide evidence-based reference for clinical practice. Methods:The Web of Science,Embase,Cochrane Library,PubMed,Wanfang Database,CNKI,VIP website,SinoMed,BMJ Best Practice,National Institute for Health and Care Excellence,Joanna Briggs Institute Library,UpToDate and the website of Agency for Healthcare Research and Quality,Society of Critical Care Medicine,American Association of Critical-Care Nurses,European Society of Intensive Care Medicine and Extracorporeal Life Support Organization were researched to collect the literature related to randomized controlled trials,systematic reviews,guidelines,evidence summaries,expert consensuses and clinical decisions in this field.The time limit for the retrieval is from the inception of databases until July 2023. Results:A total of 13 related literature were retrieved,including 4 guidelines,4 expert consensuses,3 clinical decisions and 2 system reviews.Totally 42 evidences were formulated based on retrieved literature,including adequately accessing the ability of gas exchange before weaning from veno-venous ECMO(V-V ECMO)and withdrawing from veno-arterial ECMO(V-A ECMO)as soon as possible when patients's heart function has recovered,involving six aspects such as team composition,anticoagulation measures,assessment before weaning,weaning implementation,cannula and wound management and quality measures. Conclusions:It is suggested to build a professional ECMO team based on the actual hospital situation,to follow the contemporary evidence to standardize the weaning process of patients from ECMO to ensure the patients'safety and improve the outcomes.