Objective:To investigate the effectiveness of combined teaching method integrating case-based teaching method(CBL),problem-based teaching method(PBL),and team-based teaching method(TBL)in clinical nursing teaching in pediatric intensive care unit(PICU).Methods:A total of 60 nursing students who trained in our PICU from Jan 2021 to Jun 2022 were selected as the control group,and 60 nursing students who trained in our PICU from Jul 2022 to Jun 2024 were selected as the research group.The control group received conventional nursing teaching mode,while the research group received combined teaching mode of CBL,PBL,and TBL.The scores of academic performance,logical thinking ability,self-learning ability,and clinical nursing comprehensive ability between the two groups were compared.Result:The scores of theoretical knowledge,operational skills,post-teaching Critical Thinking Disposition Inventory-Chinese Version(CTDI-CV)scale,self-directed learning readiness scale for nursing,and Mini-clinical evaluation exercise scale(Mini-CEX)in the research group were higher than those in the control group(P＜0.05).Conclusion:The combined teaching method of CBL,PBL,and TBL can effectively improve clinical nursing teaching results and comprehensive abilities of nursing students.

Objective:To investigate the effectiveness of combined teaching method integrating case-based teaching method(CBL),problem-based teaching method(PBL),and team-based teaching method(TBL)in clinical nursing teaching in pediatric intensive care unit(PICU).Methods:A total of 60 nursing students who trained in our PICU from Jan 2021 to Jun 2022 were selected as the control group,and 60 nursing students who trained in our PICU from Jul 2022 to Jun 2024 were selected as the research group.The control group received conventional nursing teaching mode,while the research group received combined teaching mode of CBL,PBL,and TBL.The scores of academic performance,logical thinking ability,self-learning ability,and clinical nursing comprehensive ability between the two groups were compared.Result:The scores of theoretical knowledge,operational skills,post-teaching Critical Thinking Disposition Inventory-Chinese Version(CTDI-CV)scale,self-directed learning readiness scale for nursing,and Mini-clinical evaluation exercise scale(Mini-CEX)in the research group were higher than those in the control group(P＜0.05).Conclusion:The combined teaching method of CBL,PBL,and TBL can effectively improve clinical nursing teaching results and comprehensive abilities of nursing students.

Objective:To investigate whether deltoid ligament (DL) injury produces axial-plane rotational instability of the ankle in patients with chronic ankle instability (CAI).Methods:A retrospective study was conducted to analyze the 33 patients with CAI who had been treated at Department of Orthopaedics, The First Affiliated Hospital of Nanjing Medical University between January 2023 and December 2024. The cohort consisted of 17 males and 16 females with an age of (31.5±9.9) years. The patients were assigned into 2 groups based on the presence of DL injury: a lateral chronic ankle instability (LCAI) group ( n=17) and a rotational ankle instability (RAI) group ( n=16). Barefoot natural walking trials were performed in all patients. Three-dimensional kinematic data were synchronously collected using an optical motion capture system (12 cameras) and force plates. A lower extremity model was constructed to obtain shank axial rotation (internal/external rotation) and rear-foot inversion/eversion angles. Continuous relative phase (CRP) analysis was employed to assess shank-rearfoot movement coupling. The mean absolute relative phase (MARP) and deviation phase (DP) were calculated. Results:There was no statistically significant difference in the clinical baseline data between the 2 groups, indicating comparability ( P>0.05). Throughout the gait cycle, no significant differences were found in shank rotation angles or rear-foot eversion angles between the RAI group and the LCAI group. However, CRP analysis revealed that during the early stance phase (initial contact and loading response), shank-rearfoot coupling was significantly lower in the RAI group than in the LCAI group. In the early stance phase, the CRP values in the RAI group were significantly higher than those in the LCAI group. The CRP curve changes in the RAI group were consistently higher in the standce phase of the entire gait cycle than those in the LCAI group, and the peak value of the CRP curve was larger in the RAI group. Concurrently, the RAI group exhibited significantly higher MARP and DP values than the LCAI group (27.48°±14.54° versus 15.21°±9.56°; 26.02°±11.73° versus 17.83°±9.82°) (both P<0.05). Conclusion:DL injury significantly damages the axial rotational stability of the ankle joint and significantly exacerbates the mechanical instability of the ankle joint in CAI patients.

Objective:To explore the latent profiles of work withdrawal behaviors of junior nurses and their relationship with workplace social capital.Methods:Using the convenience sampling method, from July to August 2023, 348 junior nurses from five Class Ⅲ and seven ClassⅡ public hospitals in Ningxia Hui Autonomous Region were selected as the research objects. They were investigated with a General Information Questionnaire, the Work Withdrawal Behavior Scale, and the Workplace Social Capital Scale. Latent profile analysis was used to explore the categories of work withdrawal behaviors of junior nurses, and the differences in workplace social capital levels among junior nurses of different categories were compared.Results:A total of 348 questionnaires were recovered online in this survey, and 342 questionnaires were valid, with a valid rate of 98.3%. The work withdrawal behaviors of 342 junior nurses could be divided into three latent profiles, including 246 junior nurses (71.9%) in the low psychological-low behavioral withdrawal group, 81 junior nurses (23.7%) in the high psychological-low behavioral withdrawal group, and 15 junior nurses (4.4%) in the high psychological-high behavioral withdrawal group. The results of the unordered multinomial Logistic regression analysis showed that gender, whether they love nursing work or not, the average number of night shifts per month, the workplace social capital, and working years were the influencing factors of the work withdrawal behaviors of junior nurses ( P<0.05) . There were statistically significant differences in the workplace social capital among the three categories of junior nurses ( H=83.82, P<0.01) . Conclusions:There are three categories of work withdrawal behaviors among junior nurses, and there are differences in workplace social capital among junior nurses of different categories. Nursing managers should intervene and support junior nurses according to the characteristics of different categories to improve their workplace social capital levels.

Objective To observe the value of intravoxel incoherent motion(IVIM)histogram parameters for predicting perineural invasion(PNI)of rectal cancer.Methods Fifty-five patients with rectal cancer were retrospectively enrolled and divided into positive group(n=23)and negative group(n=32)according to PNI or not.Histogram parameters of apparent diffusion coefficient(ADC),perfusion fraction(f),true diffusion coefficient(D)and pseudo diffusion coefficient(D*)were obtained based on MR IVIM images,including the mean,skewness,kurtosis,entropy,as well as the 25th,50th and 75th percentiles(25th,50th,75th).The above IVIM histogram parameters were compared between groups,and those with significant difference were included in binary stepwise logistic regression analysis to screen independent factors for predicting PNI status of rectal cancer.Then a combined parameter model was established.Receiver operating characteristic curve was drawn,and the area under the curve(AUC)was calculated to evaluate the efficacy of IVIM histogram parameters and combined parameter model for predicting PNI of rectal cancer.Results ADCmean,ADC25th,ADC50th,ADC75th,fmean,f25th,f50th,f75th and Dentropy in positive group were all lower than those in negative group(all P＜0.05).AUC of the above parameters for predicting PNI of rectal cancer was 0.693,0.665,0.701,0.675,0.831,0.847,0.835,0.722 and 0.785,respectively.The sensitivity,specificity and AUC of combined parameter model based on f25th and Dentropy for predicting PNI of rectal cancer was 95.65％,65.63％and 0.897,respectively.Conclusion IVIM histogram parameters could be used to predict PNI of rectal cancer effectively.

Objective To observe the value of intravoxel incoherent motion(IVIM)histogram parameters for predicting perineural invasion(PNI)of rectal cancer.Methods Fifty-five patients with rectal cancer were retrospectively enrolled and divided into positive group(n=23)and negative group(n=32)according to PNI or not.Histogram parameters of apparent diffusion coefficient(ADC),perfusion fraction(f),true diffusion coefficient(D)and pseudo diffusion coefficient(D*)were obtained based on MR IVIM images,including the mean,skewness,kurtosis,entropy,as well as the 25th,50th and 75th percentiles(25th,50th,75th).The above IVIM histogram parameters were compared between groups,and those with significant difference were included in binary stepwise logistic regression analysis to screen independent factors for predicting PNI status of rectal cancer.Then a combined parameter model was established.Receiver operating characteristic curve was drawn,and the area under the curve(AUC)was calculated to evaluate the efficacy of IVIM histogram parameters and combined parameter model for predicting PNI of rectal cancer.Results ADCmean,ADC25th,ADC50th,ADC75th,fmean,f25th,f50th,f75th and Dentropy in positive group were all lower than those in negative group(all P＜0.05).AUC of the above parameters for predicting PNI of rectal cancer was 0.693,0.665,0.701,0.675,0.831,0.847,0.835,0.722 and 0.785,respectively.The sensitivity,specificity and AUC of combined parameter model based on f25th and Dentropy for predicting PNI of rectal cancer was 95.65％,65.63％and 0.897,respectively.Conclusion IVIM histogram parameters could be used to predict PNI of rectal cancer effectively.

Objective:To investigate whether deltoid ligament (DL) injury produces axial-plane rotational instability of the ankle in patients with chronic ankle instability (CAI).Methods:A retrospective study was conducted to analyze the 33 patients with CAI who had been treated at Department of Orthopaedics, The First Affiliated Hospital of Nanjing Medical University between January 2023 and December 2024. The cohort consisted of 17 males and 16 females with an age of (31.5±9.9) years. The patients were assigned into 2 groups based on the presence of DL injury: a lateral chronic ankle instability (LCAI) group ( n=17) and a rotational ankle instability (RAI) group ( n=16). Barefoot natural walking trials were performed in all patients. Three-dimensional kinematic data were synchronously collected using an optical motion capture system (12 cameras) and force plates. A lower extremity model was constructed to obtain shank axial rotation (internal/external rotation) and rear-foot inversion/eversion angles. Continuous relative phase (CRP) analysis was employed to assess shank-rearfoot movement coupling. The mean absolute relative phase (MARP) and deviation phase (DP) were calculated. Results:There was no statistically significant difference in the clinical baseline data between the 2 groups, indicating comparability ( P>0.05). Throughout the gait cycle, no significant differences were found in shank rotation angles or rear-foot eversion angles between the RAI group and the LCAI group. However, CRP analysis revealed that during the early stance phase (initial contact and loading response), shank-rearfoot coupling was significantly lower in the RAI group than in the LCAI group. In the early stance phase, the CRP values in the RAI group were significantly higher than those in the LCAI group. The CRP curve changes in the RAI group were consistently higher in the standce phase of the entire gait cycle than those in the LCAI group, and the peak value of the CRP curve was larger in the RAI group. Concurrently, the RAI group exhibited significantly higher MARP and DP values than the LCAI group (27.48°±14.54° versus 15.21°±9.56°; 26.02°±11.73° versus 17.83°±9.82°) (both P<0.05). Conclusion:DL injury significantly damages the axial rotational stability of the ankle joint and significantly exacerbates the mechanical instability of the ankle joint in CAI patients.

Objective:To explore the latent profiles of work withdrawal behaviors of junior nurses and their relationship with workplace social capital.Methods:Using the convenience sampling method, from July to August 2023, 348 junior nurses from five Class Ⅲ and seven ClassⅡ public hospitals in Ningxia Hui Autonomous Region were selected as the research objects. They were investigated with a General Information Questionnaire, the Work Withdrawal Behavior Scale, and the Workplace Social Capital Scale. Latent profile analysis was used to explore the categories of work withdrawal behaviors of junior nurses, and the differences in workplace social capital levels among junior nurses of different categories were compared.Results:A total of 348 questionnaires were recovered online in this survey, and 342 questionnaires were valid, with a valid rate of 98.3%. The work withdrawal behaviors of 342 junior nurses could be divided into three latent profiles, including 246 junior nurses (71.9%) in the low psychological-low behavioral withdrawal group, 81 junior nurses (23.7%) in the high psychological-low behavioral withdrawal group, and 15 junior nurses (4.4%) in the high psychological-high behavioral withdrawal group. The results of the unordered multinomial Logistic regression analysis showed that gender, whether they love nursing work or not, the average number of night shifts per month, the workplace social capital, and working years were the influencing factors of the work withdrawal behaviors of junior nurses ( P<0.05) . There were statistically significant differences in the workplace social capital among the three categories of junior nurses ( H=83.82, P<0.01) . Conclusions:There are three categories of work withdrawal behaviors among junior nurses, and there are differences in workplace social capital among junior nurses of different categories. Nursing managers should intervene and support junior nurses according to the characteristics of different categories to improve their workplace social capital levels.

Monoclonal gammopathy of undetermined significance combined with renal damage is named monoclonal gammopathy of renal significance.There are few reports about IgA vasculitis in patients with monoclonal gammopathy of undetermined significance.Here,we report a case of monoclonal gammopathy of renal significance,who had manifestations of IgA vasculitis,including purpura,gastrointestinal bleeding and joint pain.The patient had elevated serum creatinine levels,prompting further investigation through immunofixation electrophoresis and bone marrow aspiration biopsy.Immunofixation electrophoresis showed IgA-λ-type monoclonal immunoglobulin,while the bone marrow aspiration biopsy suggested plas-macytosis.Kidney biopsy indicated membranous hyperplastic glomerulonephritis,light and heavy chain deposition,IgA-λ.The patient was diagnosed with monoclonal gammopathy of renal significance.In light of the elevated serum creatinine,the patient was treated with chemotherapy regimen(bortezomib+cy-clophosphamide+dexamethasone).After chemotherapy,there was no significant improvement in the patient's renal function.Subsequently,the patient experienced abdominal pain,skin purpura,joint pain and severe gastrointestinal bleeding.Gastroenteroscopy did not find the exact bleeding position.Angiography revealed hyperplasia of left jejunal artery.Surgical operation found that the bleeding site was located between the jejunum and ileum,where scattered hemorrhagic spots and multiple ulcers were present on the surface of the small intestine,with the deepest ulcers reaching the serosal layer.And the damaged intestine was removed during the operation.Intestinal pathology showed multiple intestinal submu-cosal arteritis,rusulting in intestinal wall necrosis and multiple ulcers.Considering intestinal lesions as gastrointestinal involvement of IgA vasculitis,methylprednisolone was used continually after the opera-tion,and the patient's condition was improved.However,after half a year,the patient suffered a severe respiratory infection and experienced a recurrence of serious gastrointestinal bleeding.It was considered that the infection triggered the activity of IgA vasculitis,accompanied by gastrointestinal involvement.Fi-nally,the patient died from gastrointestinal bleeding.The present case represented a patient with mono-clonal gammopathy of renal significance and IgA vasculitis,prominently presenting with renal insufficien-cy and severe gastrointestinal bleeding,making the diagnosis and treatment process complex.Patients with IgA monoclonal gammopathy who presented with abdominal pain,purpura,and arthralgia should be vigilant for the possibility of concomitant IgA vasculitis.The treatment of cases with IgA vasculitis com-bined with monoclonal gammopathy of renal significance was rather challenging.Plasma cell targeting therapy might be an effective regimen for IgA vasculitis with monoclonal gammopathy.However,patients with poor renal response to the treatment indicated poor prognosis.

Purpose/Significance To construct a human body model,bind it with actual human motion data,and achieve monitoring of human motion postures.Method/Process The paper designs a motion monitoring system based on Unity3D and MEMS inertial sensors.It utilizes MEMS inertial sensors to obtain human motion posture data,uses Euler angles for posture calculation,and sends the data to the computer system via the Bluetooth wireless transmission protocol to drive the movement of a virtual animated character,thereby achieving real-time 3D posture presentation of human actions.Result/Conclusion After experimental testing,the model can accurately monitor and simulate human motion postures.In the future,it can provide effective data analysis for application areas such as sports training and limb rehabilitation training.