Narrative is the cornerstone of interpersonal relationships and life safety. However， its important value in daily life， school education， health management， personal happiness， career development， and other aspects has been ignored. The narrative ecology of families， schools， hospitals， workplaces， and elderly care institutions is worrying， the narrative connection between parent-child and intergenerational is broken， the narrative nature of adolescents is ignored， the narrative demands of patients are neglected， narrative relationships in the workplace are indifferent， and the narrative capital of the elderly is idle. These issues have resulted in serious social problems， such as depression and suicide among adolescents， conflicts between doctors and patients， workplace and life burnout among middle-aged people， and the inability of the elderly to achieve healthy aging， which have become a “stumbling block” to the realization of holistic health. Advocating the construction of narrative ecology and interpersonal narrative connections is an important measure of achieving holistic health. Taking the “narrative concept” as the overall framework， and based on the research， education， and practice carried out by the Alliance of Narrative Medicine in Higher Education Institutions， this paper proposed that actively build China’s narrative system of life and health， to enable narrative play an active and dynamic role in the construction of narrative ecology in different spaces， such as the families， the schools， the hospitals， the workplaces， and the elderly care institutions， as well as practically improve the quality of life of the people.

[Objective]To summarize Director CHEN Yongcan's experience in treating chronic atrophic gastritis with intestinal metaplasia the pathogenesis of"deficiency in origin and toxin accumulation".[Methods]Through following Director CHEN Yongcan's outpatient service,sorting out and analyzing typical medical cases,combined with the view of Director CHEN in clinical practice,it summed up his experience in treating chronic atrophic gastritis with intestinal metaplasia from three aspects:core pathogenesis,syndrome differentiation and treatment,prescription and medication,and a proved case was attached to support the treatment.[Results]Chronic atrophic gastritis with intestinal metaplasia is one of the key links in the occurrence and development of gastric cancer.Director CHEN Yongcan believes that the"deficiency in origin and toxin accumulation"is the core pathogenesis of chronic atrophic gastritis with intestinal metaplasia."Deficiency in origin"means deficiency in the spleen and stomach,insufficiency of vital Qi;"toxin accumulation"namely turbidity-toxicity stays stagnation,accumulated and hidden.Taking the cold-heat complex syndrome as the basic point for syndrome differentiation and treatment,it's called for keeping the balance of cold and heat.According to the proportion of deficiency and excess,he treats the disease with the syndrome.The prescription is mainly self-made prescription Shiwei Xiexin Decoction,which can detoxify and benefit vital Qi.If spleen deficiency causes kidney deficiency,kidney-nourishing herbs should be added to solve this condition.If there're Qi and blood stasis,flower herbs are preferred for use.Aiming at the difference between phlegm toxin,stasis toxin and heat toxin,three pairs of triplet herbs which include Cremastrae Pseudobulbus-Salvia chinensis-Actinidia Valvata Dunn,Nidus Vespae-Herba Artemisiae Anomalae-Rhizoma Curcumae and Taraxacum mongolicum-Scutellariae Barbatae Herba-Hedyotis Diffusa are selected for treatment.The syndrome differentiation of the case was spleen deficiency and toxin accumulation,and complex cold-heat.The treatment was invigorating the spleen and detoxifying,and adjusting cold-heat in balance,and Shiwei Xiexin Decoction was used,considering the combination of blood stasis and toxin accumulation,Nidus Vespae-Herba Artemisiae Anomalae-Rhizoma Curcumae were selected.At the follow-up visit,because of obstruction of Qi and blood and imbalance of Qi movement,and Sanhua Baicao Drink to gently promote depression.In the third visit,considering age growth,the liver and kidney were gradually declining,the long-term illness damaged primordial Qi,and the Sijun Zhenyuan Decoction was used to invigorate the spleen and tonify the kidney,consolidate the basis and cultivate primordial Qi.[Conclusion]Director CHEN's experience in differentiating and treating chronic atrophic gastritis with intestinal metaplasia from"deficiency in origin and toxin accumulation"is unique and effective,which is worthy of promotion and learning.

Chronic atrophic gastritis with intestinal metaplasia is a necessary stage for chronic gastritis to develop into gastric cancer.Chen Yongcan believes that the theory of"yang transforming into qi and yin forming shape"can explain the development and diagnosis of chronic atrophic gastritis with intestinal metaplasia.The deficiency of"yang transforming into qi"leads to too much"yin forming shape",which changes the physiological function of the spleen and stomach,and then develops into the pathological process of chronic atrophic gastritis with intestinal metaplasia.Based on the theory of"yang transforming into qi and yin forming shape",the pathogenesis of this disease was briefly analyzed.In clinical treatment,the state of yin and yang was first identified,and the treatment principle of tonifying yang qi to remove yin turbidity was put forward to achieve the purpose of treating both manifestation and root causes.

Objective To analyze the risk factors of lower limb deep vein thrombosis(DVT)after the closed Pilon fracture surgery,and to build a nomograph prediction model.Methods A total of 182 patients with closed Pilon fracture who underwent surgical treatment in our hospital from June 2019 to June 2022 were retrospectively analyzed,according to the occurrence of postoperative DVT,the patients were divided into two groups:43 cases in DVT group and 139 cases in non-DVT group.Univariate and multivariate Logistic regression analysis was applied to screen the risk factors of lower limb DVT after closed Pilon fracture surgery;R software was applied to build a nomograph model for predicting lower limb DVT after closed Pilon fracture surgery,and receiver operating characteristic(ROC)and calibration curve were applied to verify the nomograph model.Results Logistic regression analysis showed that the history of diabetes mellitus,risk assessment of thrombosis as medium and high risk,and postoperative infection were independent risk factors for lower limb DVT after closed Pilon fracture surgery(P＜0.05).The area under the ROC curve was 0.716(95％CI:0.629-0.804).The slope of calibration curve was close to 1,and H-L goodness of fit test x2=2.556,P=0.635.Conclusion The history of diabetes,the result of thrombosis risk assessment as"medium-high risk",and the postoperative infection occurred at the surgical site are independent risk factors for lower limb DVT after closed Pilon fracture surgery.The nomogram prediction model constructed by integrating the above three independent risk factors can effectively predict lower limb DVT after closed Pilon fracture surgery,with high differentiation and consistency.

Objective:To investigate the efficacy and safety of anlotinib in distant metastatic radioactive iodine-refractory differentiated thyroid cancer (RAIR-DTC).Methods:Retrospective analysis was performed on 17 patients with distant metastatic RAIR-DTC (6 males, 11 females, age: 57.0(45.5, 63.0) years) from Affiliated Hospital of Qingdao University between October 2018 and February 2023, including 13 patients receiving first-line treatment and 4 patients receiving second-line treatment with anlotinib. The changes of serum thyroglobulin (Tg) during the treatment of anlotinib, the changes of maximum diameter of the target lesion at the last follow-up compared with the diameter at baseline, the imaging efficacy, and treatment-related adverse events were analyzed. The serological and imaging effects of the first-line treatment group and the second-line treatment group were compared. The Fisher exact test was used to analyze the differences between groups.Results:The follow-up time of 17 patients was 17.3(9.5, 21.4) months, and the objective response rate (ORR) and disease control rate (DCR) were 7/17 and 16/17, respectively. There were no significant differences of ORR (6/13 vs 1/4; P=0.603) and DCR (13/13 vs 3/4; P=0.235) between the first-line and second-line treatment groups. The change rates of serum Tg at 3, 6 weeks and the last follow-up were -30.2%(-61.2%, -15.5%), -64.8%(-90.6%, -32.3%), and -85.8%(-96.1%, -50.7%), respectively. At the last follow-up, the change rate of maximum diameter of target lesions was -20.0%(-45.0%, -5.2%). The incidence of treatment-related adverse reactions was 14/17, and 2 patients (2/17) had grade 3 or above adverse reactions. Conclusion:Anlotinib shows superior efficacy with tolerable toxicity in the first-line treatment of distant metastatic RAIR-DTC, and hopefully plays an important role in second-line treatment for RAIR-DTC resistant to sorafenib.

Objective:To compare the effect of F7.5 ureteroscope and other types of ureteroscope (F8.5, F9.0, F9.2, F9.6) in the control of intrapelvic pressure during operation.Methods:F7.5 super thin flexible ureteroscope and other 4 kinds of disposable flexible ureteroscopes (F8.5, F9.0, F9.2, F9.6) were combined with 3 kinds of ureteral guidance sheaths to form 15 endoscope-sheath combinations. The real outer diameter of each flexible ureteroscope was measured and the effective ratio of endoscope-sheath diameter was calculated. The real outer diameter of each soft mirror was measured and the effective sheath ratio was calculated. The irrigation during lithotripsy was simulated in a 3D printed kidney model, the irrigation pressure of 50-500 cmH 2O was set, and the stable intrapelvic pressure and flow rate were measured. The line chart was drawn and the relationship between intrapelvic pressure and irrigation pressure was analyzed by linear regression. The intrapelvic pressure between different endoscope-sheath combinations and different endoscope groups were compared respectively. Results:The ratio of endoscope-sheath diameter for all combinations ranges from 0.62 to 0.92, with 0.75, 0.68 and 0.62 for the F7.5 flexible ureteroscopes and F10/12, F11/13 and F12/14 sheath combinations respectively. Intrapelvic pressure and flow rate showed an approximately linear relationship with irrigation pressure in all groups. The F7.5 flexible scope with the F10/12, F11/13 and F12/14 sheaths all provided intrapelvic pressures below 40 cmH 2O. The F12/14 sheath-F7.5 scope combination produced the lowest intrapelvic pressure of 1.47 cmH 2O at 50 cmH 2O irrigation pressure and the highest flow rate of 74.24 ml/min at 500 cmH 2O irrigation pressure. When combined with the F10/12 sheath, only the F7.5 flexible scope was able to maintain a safe intrapelvic pressure of only 25.90 cmH 2O throughout. Analysis of the variability of intrapelvic pressure using the combination of instruments as the grouping variable suggested a significant overall difference( P<0.05). Analysis of the variability between groups using the different flexible scope as the grouping variable showed that the F7.5 scope group had significantly lower intrapelvic pressure compared to the other four groups( P<0.05). Conclusions:The F7.5 super thin flexible scope has the best intrapelvic pressure control of the five flexible scopes due to the significantly reduced ratio of endoscope-sheath diameter for the instrument combination and the ability to fit a thinner guide sheath while maintaining safe pelvic pressure.

Purpose: Hungry bone syndrome after parathyroidectomy is an important clinical problem in patients on maintenance hemodialysis. We examined the effect of an enhanced recovery after surgery (ERAS) program on the incidence of hungry bone syndrome after parathyroidectomy in this population. Methods: This single-institution, retrospective study analyzed 108 patients on hemodialysis who underwent parathyroidectomy for secondary hyperparathyroidism. Patients were classified into the pre-ERAS (n = 52) and post-ERAS (n = 56) groups. The ERAS program identified high-risk patients and enforced aggressive measures to normalize calcium levels following parathyroidectomy. Results: There was no significant difference in age, sex, body weight, presenting symptoms, preoperative calcium and alkaline phosphatase levels, postoperative intact parathyroid levels, postoperative calcium levels at 1 and 24 hours after parathyroidectomy, and 30-day readmission rates between the groups. The post-ERAS group had significantly higher levels of postoperative calcium at 48 and 72 hours after parathyroidectomy, but a lower incidence of hungry bone syndrome and shorter postoperative length of stay. Patients with hungry bone syndrome had higher preoperative levels of alkaline phosphatase and intact parathyroid, longer postoperative length of stay, and were less likely to have been part of the ERAS program. High preoperative alkaline phosphatase levels and absence of the ERAS program were independent risk factors for hungry bone syndrome after parathyroidectomy. Conclusion The ERAS program reduced the incidence of hungry bone syndrome and shortened the postoperative length of stay in patients on maintenance hemodialysis who underwent parathyroidectomy for secondary hyperparathyroidism.

Objective:To understand the real experience of work alienation among nurses with master′s degrees working in first-class hospitals.Methods:A descriptive qualitative research method of qualitative research was employed to conduct in-depth interviews with 15 nurses with master′s degrees from five tertiary first-class hospitals in Tianjin from January 2022 to March 2022. Nvivo 12 software was used to manage the interview data. The metic analysis method was used to refine the themes and subthemes.Results:Three themes were: work alienation performance of nurses with master′s degree (negative emotional experience, passive behavioural performance), reasons for work alienation of nurses with master′s degree (low self-worth, estranged coworker relationships and ambiguous work plan), needs of professional development coping with work alienation (needs of scientific research work, needs of scientific promotion system and salary performance, needs of organizational recognition and training and learning).Conclusions:Nurses with master′s degrees experience work alienation. Managers are advised to focus on improve these nurses′ alienation performance, explore the reasons and meet their personal needs with nursing job degrees, which then may in turn improve their sense of self-worth, and assist in developing positive attitude towards nursing work and reducing work alienation.

【Objective】 To observe the effects of hsa-miR-124-3p.1 in inhibiting epithelial-mesenchymal transition （EMT）， migration and invasion of human gastric cancer cells induced by transforming growth factor β1 （TGF-β1） by targeting tumor necrosis factor receptor-associated factor 6 （TRAF6）. 【Methods】 A total of 43 gastric cancer tissues and 43 normal para-carcinoma tissues were collected. The human gastric mucosal epithelial cells GES-1 and gastric cancer cells （NCI-N87， MGC-803， BGC-823， SGC-7901， and MKN-45） were cultured. The expressions of miR-124-3p.1 and TRAF6 in tissues and cells were detected by fluorescent quantitative PCR and Western blotting. The targeted relationship between miR-124-3p.1 and TRAF6 was verified by dual-luciferase reporter gene system assay. SGC-7901 cell lines with miR-124-3p.1 and TRAF6 overexpression were constructed. The cells were induced by TGF-β1. The invasion and migration abilities of the cells were evaluated by Transwell chamber assay and scratch test. 【Results】 Compared with normal para-carcinoma tissues and normal gastric mucosal cells， the expression of miR-124-3p.1 was downregulated， while the expressions of TRAF6 mRNA and protein were upregulated in gastric cancer tissues and cells （P<0.05）. Compared with control group， expression of E-cadherin in cells was downregulated， expressions of N-cadherin and Vimentin were upregulated， invasion and migration rates of cells were increased in TGF-β1 group （P<0.05）. Compared with TGF-β1 group， after cells were transfected with miR-124-3p.1 mimic， the expression of E-cadherin was upregulated， the expressions of N-cadherin and Vimentin were down-regulated， and invasion and migration rates of cells were decreased （P<0.05）. Compared with miR-124-3p.1 mimic group， invasion and migration rates of cells were increased in TGF-β1+mimic+TRAF6 group， expressions of TRAF6， N-cadherin and Vimentin were up-regulated， and the expression of E-cadherin was down-regulated （P<0.05）. 【Conclusion】 hsa-miR-124-3p.1 is lowly expressed in gastric cancer. Overexpression of miR-124-33p.1 can inhibit EMT， cell invasion and migration induced by TGF-β1. And the action mechanism may be related to the downregulated expression of TRAF6.

Objective:To test the reliability and validity of the Chinese version of the Quality of Life in Adult Cancer Survivors (QLACS) in Chinese cancer Survivors.Methods:We translated the scale following the procedure of translation, integration and back translation. After modifying the scale and adapting it in Chinese culture, the reliability and validity of the QLACS scale was tested in a large sample of 222 cancer survivors.Results:The Chinese version of QLACS had 47 items with a total of twelve domains. Principal component analysis resulted in an 8-factor structure of the explaining 74.393% of the seven generic domains′ variance, and an 5-factor structure of the explaining 71.937% of the five cancer-specific domains′ variance. The item level content validity index (I-CVI) was 0.89-1.00, and the total content average content validity index (S-CVI/) was 0.93. The Cronbach′s α coefficient for the total QLACS score was 0.935, and 0.933 for generic domains, and 0.865 for cancer-specific domains.Conclusions:The Chinese version of QLACS appears to possess adequate validity, reliability and internal consistency. The newly translated Chinese version of QLACS may be used to assess the quality of cancer survivors in China.