Objective To evaluate the application of evidence-based perioperative patient-controlled analgesia(PCA)management in patients with liver cancer receiving transcatheter arterial chemoembolization(TACE)treatment.Methods By using the application model of clinical evidence-based practice,the review indicators were formulated based on the best evidence.The baseline assessment was conducted,the barrier factors were analyzed,the best clinical decision was made,the implementation steps of PCA management,including training,monitoring,education,etc.were refined,and two rounds of clinical review were carried out.The knowledge-belief-practice level and the implementation of review indicators in 50 medical and nursing staff engaged in PCA management,as well as the changes in pain scores,the incidence of adverse reactions due to PCA management,and the patient's satisfaction in 159 patients after the application of evidence were compared with their corresponding values determined before the application of evidence.Results After implementing the evidence-based practice plan and applying the evidence,at multiple time points the pain scores and the incidences of adverse reactions were decreased significantly(P＜0.05),the patient's satisfaction increased remarkably(P＜0.01),the execution rate of medical and nursing staff for the review indicators were strikingly increased(P＜0.01),and the knowledge-belief-practice level concerning PCA management was prominently improved(P＜0.01).Conclusion The implementation of perioperative PCA management in patients with liver cancer receiving TACE treatment can help to reduce the perioperative pain level,improve the patient discomfort,increase the patient's satisfaction degree,and improve the ability of medical staff in performing PCA management and evidence-based practices.

Objective:To explore the current situation and influencing factors of quality of life of septic patients in intensive care unit (ICU) after discharge, and to provide theoretical basis for clinical early psychological intervention and continuity of care.Methods:A prospective observational study was conducted. The septic patients who were hospitalized in the department of critical care medicine of the Affiliated Hospital of Jining Medical University and discharged with improvement from January 1 to December 31, 2022 were selected as the research objects. The demographic information, basic diseases, infection site, vital signs at ICU admission, severity scores of the condition within 24 hours after ICU admission, various biochemical indexes, treatment process, and prognostic indexes of all the patients were recorded. All patients were assessed by questionnaire at 3 months of discharge using the 36-item short-form health survey scale (SF-36 scale), the activities of daily living scale (ADL scale), and the Montreal cognitive assessment scale (MoCA scale). Multiple linear regression was used to analyze the factors influencing the quality of life of septic patients after discharge from the hospital.Results:A total of 200 septic patients were discharged with improvement and followed up at 3 months of discharge, of which 150 completed the questionnaire. Of the 150 patients, 57 had sepsis and 93 had septic shock. The total SF-36 scale score of septic patients at 3 months of discharge was 81.4±23.0, and the scores of dimensions were, in descending order, role-emotional (83.4±23.0), mental health (82.9±23.6), bodily pain (82.8±23.3), vitality (81.6±23.2), physical function (81.4±23.5), general health (81.1±23.3), role-physical (79.5±27.0), and social function (78.8±25.2). There was no statistically significant difference in the total SF-36 scale score between the patients with sepsis and septic shock (82.6±22.0 vs. 80.7±23.6, P > 0.05). Incorporating the statistically significant indicators from linear univariate analysis into multiple linear regression analysis, and the results showed that the factors influencing the quality of life of septic patients at 3 months after discharge included ADL scale score at 3 months after discharge [ β= 0.741, 95% confidence interval (95% CI) was 0.606 to 0.791, P < 0.001], length of ICU stay ( β= -0.209, 95% CI was -0.733 to -0.208, P = 0.001), duration of mechanical ventilation ( β= 0.147, 95% CI was 0.122 to 0.978, P = 0.012), total dosage of norepinephrine ( β= -0.111, 95% CI was -0.044 to -0.002, P = 0.028), mean arterial pressure (MAP) at ICU admission ( β= -0.102, 95% CI was -0.203 to -0.007, P = 0.036) and body weight ( β= 0.097, 95% CI was 0.005 to 0.345, P = 0.044). Conclusions:The quality of life of patients with sepsis at 3 months after discharge is at a moderately high level. The influencing factors of the quality of life of patients with sepsis at 3 months after discharge include the ADL scale score at 3 months after discharge, the length of ICU stay, the duration of mechanical ventilation, the total dosage of norepinephrine, MAP at ICU admission and body weight, and healthcare professionals should enhance the treatment and care of the patients during their hospitalization based on the above influencing factors, and pay attention to early psychological intervention and continued care for such patients.

Objective: To provide ideas for the modernization of pulse diagnosis in traditional Chinese medicine (TCM) by comparing and analyzing the current status and trends of modern research on pulse diagnosis in China and abroad, using bibliometric and visualization software. Methods: Modern research literature on pulse diagnosis was searched in China National Knowledge Infrastructure (CNKI) database from the foundation to May 31, 2023, and in Science Citation Index Expanded (SCIE) from January 1, 2003, to May 31, 2023. After further screening, Microsoft Excel 2019 was used for statistical analysis of publication volume, and CiteSpace (6.1.R6) and VOSviewer (1.6.20) softwares were employed for visual analysis of journals, countries/regions, authors, institutions, keywords, etc. Results: This study included a total of 764 articles in Chinese and 1 459 articles in English. The publication trend of pulse diagnosis research in SCIE database showed an overall fluctuating upward trend, while it exhibited a fluctuating downward trend after 2007 in CNKI database. The volume of English research literature has consistently exceeded that of Chinese literature since 2009. Publications on pulse diagnosis research involved 74 countries/regions. The related journals covered various disciplinary fields, including mathematics, physics, chemistry, and computer science. The most prolific author in CNKI database was WANG Yiqin (Shanghai University of Traditional Chinese Medicine), while the highest number of publications was attributed to ZHANG David (The Hong Kong Polytechnic University) in SCIE database. High-volume institutions in pulse diagnosis research in China and abroad were predominantly TCM research institutions. However, comprehensive universities and other research institutions also made noteworthy contributions. In recent years, hot topics in the modernization of pulse diagnosis research in China included pulse waves, sensors, and artificial intelligence. Foreign research focused on pulse diagnosis systems, sensors, pulse feature extraction, pulse signal analysis, pulse detection, and efficiency of use. Conclusion Chinese scholars have shown notable participation and emphasis in the modernization research of pulse diagnosis, involving a wide range of disciplinary fields and indicating a characteristic of multidisciplinary cross-fusion development. The hotspots andtrends in the modernization of pulse diagnosis research primarily concentrate on the study of pulse condition and signal acquisition, the integration, development, and optimization of various algorithms with pulse diagnosis equipment, and the practical application research of existing objectified outcomes of pulse diagnosis.

Objective:To construct a nomogram model predicting the occurrence of acute kidney injury (AKI) in patients with sepsis in the intensive care unit (ICU), and to verify its validity for early prediction.Methods:Sepsis patients admitted to the ICU of the Affiliated Hospital of Jining Medical University from April 2015 to December 2021 were retrospectively included, and those who met the inclusion criteria were randomly divided into training and validation sets at a ratio of 7:3. Univariate and multivariate logistic regression models were used to identify independent risk factors for AKI in patients with sepsis, and a nomogram was constructed based on the independent risk factors. Calibration curve, receiver operating characteristic (ROC) curve, and decision curve analysis (DCA) were used to evaluate the nomogram model.Results:741 patients with sepsis were included in the study, 335 patients developed AKI within 7 d of ICU admission, with an AKI incidence of 45.1%. Randomization was performed in the training set ( n=519) and internal validation set ( n=222). Multivariate logistic analysis revealed that acute physiology and chronic health status score Ⅱ, sequential organ failure score, serum lactate, calcitoninogen, norepinephrine dose, urea nitrogen, and neutrophil percentage were independent factors influencing the occurrence of AKI, and a nomogram model was constructed by combining these variables. In the training set, the AUC of the nomogram model ROC was 0.875 (95% CI: 0.767-0.835), the calibration curve showed consistency between the predicted and actual probabilities, and the DCA showed a good net clinical benefit. In the internal validation set, the nomogram model had a similar predictive value for AKI (AUC=0.871, 95% CI: 0.734-0.854). Conclusions:A nomogram model constructed based on the critical care score at admission combined with inflammatory markers can be used for the early prediction of AKI in sepsis patients in the ICU. The model is helpful for clinicians early identify AKI in sepsis patients.

Objective: To investigate the ameliorative effects of Mushroom on adipose tissue inflammation and glucolipid metabolism in mice fed a high-fat diet, and to provide a theoretical basis for the mechanisms of Mushroom regulating glucolipid metabolism and inflammatory responses. Methods: C57 BL/6 J mice were fed with normal diet(LF) group, high-fat diet(HF)group and high-fat diet + Mushroom(HF+Mushroom) group for 15 weeks.Then, body weight subcutaneous and epididymal white adipose tissue weight were measured. The morphological changes of adipose tissues were compared by HE staining, and the expression of genes related to inflamation, glycolysis and fatty acid oxidation pathways were detected by RT-PCR and Western blot. Results: Compared with the LF group, the HF group had increased body weight, increased subcutaneous and epididymal white fat weight and adipocyte size, and upregulated expression of tumor necrosis factor-α(TNF-α), interleukin-6(IL-6), monocyte chemoattractant protein-1(MCP-1), CD68, inducible nitric oxide synthase(iNOS), pyruvate kinase(PK), phosphofructokinase(PFK), hypoxia inducible factor-1α(HIF-1α) and peroxisome proliferator activated receptor alpha(PPARα) in adipose tissues, while the expression of carnitine palmitoyl transferase-1 A(CPT-1 A), cytochrome P450 4 a10(CYP4 a10) and medium-chain acyl-coenzyme a dehydrogenase(MCAD) were downregulated(P<0.05). Compared with the HF group, Mushroom supplementation reduced body weight, adipose tissue weight and adipocyte size, and downregulated the expression of pro-inflammatory factors and glycolytic pathway-related factors in adipose tissues, while the expression of fatty acid oxidation pathway-related factors were upregulated(P<0.05). Conclusion Mushroom can ameliorate inflammation and disorders of glycolipid metabolism in adipose tissues of obese mice.

Objective:To develop and validate a nomogram for predicting the 1-and 3-year survival rates of patients receiving peritoneal dialysis.Methods:Patients who underwent peritoneal dialysis for the first time in Zhujiang hospital from January 1, 2010 to December 31, 2017 were enrolled. The patients from January 1, 2014 to December 31, 2017 were enrolled in a training dataset. Baseline clinical data were collected and the primary endpoint was all-cause death. Cox proportional hazard regression models were used to analyze risk factors affecting the survival rates. Nomograms were generated using the R rms package. The Harrell' concordance index (C-index), receiver operating characteristic curve and calibration curve were used to verify the performance of the model. Patients who underwent peritoneal dialysis from January 1, 2010 to December 31, 2013 were then selected to validate the external predictive accuracy of the prediction models.Results:The prediction cohort enrolled 457 patients, with a median follow-up time of 27.67(18.37, 39.22) months, and 64 patients (14.00%) died during follow-up. The 1-and 3-year cumulative survival rates were 96.4% and 83.0%. Multivariate analysis showed that aging (every 1 year old increase, HR=1.07, 95% CI 1.04-1.09, P<0.001), stroke ( HR=3.63, 95% CI 1.93-6.85, P<0.001), higher cholesterol (every 1 mmol/L increase, HR=1.51, 95% CI 1.20-1.89, P<0.001), higher neutrophil-to-lymphocyte ratio (every 1 increase, HR=1.12, 95% CI 1.05-1.20, P=0.001), and lower albumin ( HR=0.89, 95% CI 0.82-0.95, P=0.001) were independent risk factors affecting the survival rates of PD patients. The C-index of the prediction cohort and the validation cohort were 0.815(95% CI 0.765-0.865) and 0.804(95% CI 0.744-0.864, respectively). Both internally and externally verified calibration curves showed that the predicted results were close to the actual survival rates. Conclusion:Based on age, blood total cholesterol level, stroke history, and NLR, the prognosis prediction model of peritoneal dialysis patients established with nomogram can help predict the 1-year and 3-year survival rates of peritoneal dialysis patients.

A 69-year-old male patient with peripheral T-cell lymphoma received chemotherapy with intravenous doxorubicin liposome. In the first chemotherapy cycle, no obvious adverse reactions appeared. In the second chemotherapy cycle, the patient developed transient muscle soreness during the IV infusion of doxorubicin liposome. In the third chemotherapy cycle, dexamethasone and chlorphenamine were given to prevent anaphylaxis before doxorubicin liposome treatment and the infusion rate was controlled in a standardized way. However, at about 20 minutes of infusion, the patient developed nausea and vomiting. The infusion of doxorubicin was stopped immediately and replaced by IV infusion of 0.9% sodium chloride injection 250 ml. Then the patient developed facial numbness, laryngeal pain, neck discomfort, and multiple parts of skin rash with pruritus. The electrocardiogram monitoring showed heart rate 130 times/min, blood pressure 80/50 mmHg, and oxygen saturation 0.98. The patient was given oxygen inhalation and in half-lying position following the doctor′s advice, but the patient developed dyspnea, hoarseness, and slurred speech 20 minutes later. Physical examination showed the patient′s tongue was hypertrophic, his neck was swollen and thickened. Acute laryngeal edema induced by doxorubicin liposome was considered. Intravenous injection of dexamethasone 10 mg, IV infusion of 10% calcium gluconate, and aerosol inhalation of budesonide inhalation aerosol were given immediately and about 3 hours later, the symptoms gradually improved. Two days later, the allergic symptoms disappeared.

A 69-year-old male patient with peripheral T-cell lymphoma received chemotherapy with intravenous doxorubicin liposome. In the first chemotherapy cycle, no obvious adverse reactions appeared. In the second chemotherapy cycle, the patient developed transient muscle soreness during the IV infusion of doxorubicin liposome. In the third chemotherapy cycle, dexamethasone and chlorphenamine were given to prevent anaphylaxis before doxorubicin liposome treatment and the infusion rate was controlled in a standardized way. However, at about 20 minutes of infusion, the patient developed nausea and vomiting. The infusion of doxorubicin was stopped immediately and replaced by IV infusion of 0.9% sodium chloride injection 250 ml. Then the patient developed facial numbness, laryngeal pain, neck discomfort, and multiple parts of skin rash with pruritus. The electrocardiogram monitoring showed heart rate 130 times/min, blood pressure 80/50 mmHg, and oxygen saturation 0.98. The patient was given oxygen inhalation and in half-lying position following the doctor′s advice, but the patient developed dyspnea, hoarseness, and slurred speech 20 minutes later. Physical examination showed the patient′s tongue was hypertrophic, his neck was swollen and thickened. Acute laryngeal edema induced by doxorubicin liposome was considered. Intravenous injection of dexamethasone 10 mg, IV infusion of 10% calcium gluconate, and aerosol inhalation of budesonide inhalation aerosol were given immediately and about 3 hours later, the symptoms gradually improved. Two days later, the allergic symptoms disappeared.

Objective To explore the relationship among psychological flexibility,coping style and job burnout of nurses.Methods A total of 694 nurses from one district level grade A tertiary general hospital in Yunnan were assessed using acceptance and action questionnaire 2nd edition (AAQ-Ⅱ),simplified coping style questionnaire (SCSQ) and nursing burnout scale (NBS).The relationship among psychological flexibility,coping style and job burnout of nurses was analyzed using structural equation model and Bootstrap test.Results (1) Correlation analysis showed that the total scores of AAQ-Ⅱ (21.81 ± 8.23),job burnout (22.71 ± 6.60) and its three dimensions including emotional exhaustion (8.93 ± 2.87),depersonalization (6.64±2.30)as well as reduced personal accomplishment(7.14±2.52) were positively correlated with negative coping dimension of coping style (10.86±4.99) (r=0.324-0.510,all P＜0.01),while negatively correlated with positive coping dimension(26.44±5.86) (r=-0.102--0.143,all P＜0.01).(2) Structural equation model analysis showed that positive and negative coping dimension had partial mediating effects on the relationship between psychological flexibility and job burnout (x2/df=2.30,GFI =0.91,AGFI =0.90,NFI=0.90,IFI=0.93,TLI=0.92,CFI=0.93,RMSEA=0.04).(3) Bootstrap test showed that the mediating effect sizes for positive and negative coping were 3.8％ and 8.9％ respectively and totally mediating effect size of coping style was 12.7％.Psychological flexibility had much larger effects on job burnout,and the direct effect size was 87.3％.Conclusion Coping style plays a mediating role in the relationship between psychological flexibility and job burnout,but its effect is less important.Psychological flexibility plays a major role and more directly influences on job burnout.

Objective? To establish, implement and evaluate the pain control quality system for patients with total knee arthroplasty(TKA). Methods? Through literature search and interviews with medical staff and retrospective reviews of TKA cases in orthopedic wards, the problems in pain control of TKA patients during perioperative period were analyzed. According to the evidence-based practice guideline and the existing problems in pain nursing practice, the pain control quality system was constructed. From January to November 2018, 75 TKA patients in Orthopedic Department, Ningbo First Hospital were selected as the research objects and randomly divided into the control group (n=35) and the intervention group (n=40). The control group received the routine pain nursing mode, and the intervention group was managed by the pain control quality system. The static and dynamic VAS scores on the 1st, 3rd and 7th day after TKA, the incidence of analgesia-related complications and the quality of pain nursing were compared between the two groups. Results? There were significant statistical differences in static and dynamic VAS scores of knee joint between the two groups on the 1st, 3rd and 7th day after operation (P＜0.05). There was no statistical difference in the incidence of analgesia-related complications between the two groups (P＞ 0.05). The total score of TKA perioperative pain nursing quality in the intervention group was 84 (80, 85), while that of the control group was 56 (53, 58). The difference between the two groups was statistically significant (P＜0.01). Conclusions? The construction of pain control quality system can effectively improve the level of perioperative pain management of TKA, the quality of pain nursing care, and improve the perioperative pain of TKA patients.