Objective:To systematically evaluate qualitative studies on the perceptions and feelings of nursing staffs implementing neonatal palliative care, aiming to provide insights for advancing clinical practice in China.Methods:The databases including China National Knowledge Infrastructure, Wanfang, VIP, Chinese Biomedical Literature Database, PubMed, CINAHL, Embase, Cochrane Library, Web of Science, and PsycINFO were included to retrieve the literature on the perceptions and feelings of nursing staffs from inception until March 28, 2024. The literature quality was assessed utilizing the Joanna Briggs Institute Australian Centre for Evidence-Based Health Care Quality Assessment Criteria for Qualitative Research (2016), and the findings were synthesized through Meta-integration techniques.Results:A total of 12 studies were included, yielding 46 themes were extracted; 8 categories were summarized and 3 synthesis results were obtained: nursing staffs experience both negative and positive aspects, the real-life challenges faced by nursing staffs in implementing neonatal palliative care, and the practical experiences and needs of nursing staffs regarding neonatal palliative care.Conclusions:It is crucial to continually address nursing staffs′ negative emotions and tackle challenges related to staffing, training, communication, and ethical dilemmas to ensure appropriate end-of-life symptom management in neonatal palliative care.

Objective To investigate the serum microRNA(miR)-125a-5p,miR-127-3p expression and clinical significance in patients with hepatitis B virus(HBV)-associated hepatocellular carcinoma(HCC).Meth-ods A total of 90 HBV-associated HCC patients admitted to a hospital from January 2018 to October 2020 were selected as the HBV-associated HCC group.Another 90 healthy subjects from the same period were se-lected as the control group.Serum miR-125a-5p and miR-127-3p expressions were detected by real-time fluo-rescence quantitative polymerase chain reaction.To analyze the relationship between miR-125a-5p and miR-127-3p expression and pathological features of patients with HBV-associated HCC.Patients with HBV-associ-ated HCC were divided into high and low expression groups according to the mean values of serum miR-125a-5p and miR-127-3p expression,and the different survival curves of each groups were plotted by the Kaplan-Meier method.Factors affecting the prognosis of patients with HBV-associated HCC were analyzed by Cox re-gression,and the predictive value of serum miR-125a-5p and miR-127-3p expression on the death of patients with HBV-associated HCC was analyzed by receiver operating characteristic(ROC)curve.Results The rela-tive expression levels of miR-125a-5p and miR-127-3p in HBV-associated HCC group were lower than those in control group,with statistical significance(P＜0.05).There were significant differences in the expression of miR-125a-5p and miR-127-3p in serum of HBV-associated HCC patients with different tumor size,differentia-tion degree,vascular invasion,TNM stage and lymph node metastasis(P＜0.05).Kaplan-Meier survival curve analysis showed that the 3-year overall survival rate(64.58％)of the group with high expression of miR-125a-5p was higher than that of the group with low expression of miR-125a-5p(38.10％).The 3-year overall survival rate of miR-127-3p high expression group(66.00％)was higher than that of miR-127-3p low expres-sion group(35.00％),and the difference was statistically significant(x2=7.770,9.507,P=0.005,0.002).The independent risk factors for death in HBV-associated HCC patients were maximum tumor diameter ≥5 cm,low differentiation,vascular invasion,TNM stage Ⅲ-Ⅳ,and lymph node metastasis,and the independent protective factors were elevated miR-125a-5p and miR-127-3p.ROC curve analysis results showed that the are-a under the curve(AUC)for the combined prediction of serum miR-125a-5p and miR-127-3p expression was 0.907,which was significantly higher than the AUC for the individual prediction of serum miR-125a-5p and miR-127-3p expression(0.790,0.787),with a statistically significant difference(Z=2.691,3.152,P=0.007,0.002).Conclusion The low expression of serum miR-125a-5p and miR-127-3p in HBV-associated HCC pa-tients is related to tumor maximum diameter,differentiation degree,vascular invasion,TNM stage and prog-nosis.The combined expression of serum miR-125a-5p and miR-127-3p has a high predictive value for the prognosis of HBV-associated HCC patients.

Objective Developing a new type of full-face respiratory protective mask for nuclear facility sites to enhance the sound transmission function and improve the facial adaptability. Methods Combined with feedback from on-site practical needs, this study utilized finite element simulation and ergonomic design methods to investigate the voice transmission units of full-face masks and the facial features of workers at key nuclear facilities. Based on the research results, a new full-face respiratory protection mask structure was designed. Results The optimized structure of passive thin film voice transmission unit significantly enhanced voice transmission efficiency, reducing average voice transmission loss by approximately 70% compared to the control group using thin plate units of equivalent thickness. The existing facial feature test panels insufficiently cover and unevenly classify the facial features of workers at key nuclear facilities. In this study, a specialized test panel based on measurement data achieved a total coverage of 98.5% with high distribution uniformity within each class, providing effective guidance for redesigning full-face mask structural parameters. In comparison to foreign products currently utilized in nuclear facilities, the newly designed full-face mask structure exhibited excellent tightness and structural safety and reliability, and can be cleaned, decontaminated, and reused. Conclusion The results of this study provide significant guidance for improving and optimizing full-face respiratory protection mask used at nuclear facilities, as well as promoting domestic production of high-quality full-face respiratory protection masks.

Objectives:To evaluate the association between estimated pulse wave velocity(ePWV)and risk of new-onset diabetes. Methods:A total of 82 440 employees without prior diabetes who participated in the health examination from July 2006 to October 2007 were selected as the observation cohort,participants were followed-up for a mean of(13.19±3.73)years.The study population was divided into four groups according to the ePWV quartiles:group Q1(ePWV<12.35 m/s,n=20 610),group Q2(12.35 m/s≤ePWV<13.74 m/s,n=20 610),group Q3(13.74 m/s≤ePWV<15.16 m/s,n=20 611),and group Q4(ePWV≥15.16 m/s,n=20 609).ROC curve was used to analyze the predictive value of ePWV for new-onset diabetes.The incidence density of diabetes in each group was calculated.After adjustment for the traditional cardiovascular risk factors(including sex,smoking,drinking,exercise,education level,family history of cardiovascular disease,history of myocardial infarction,history of stroke,body mass index,total cholesterol,fasting blood glucose,uric acid and high-sensitivity C-reactive protein),multivariate Cox regression models were used to evaluate the association between ePWV and risk of new-onset diabetes. Results:The area under the ROC curve of ePWV was 0.60 in the prediction of new-onset diabetes,and the optimal cut-offvalue was 12.78 m/s.With the increase of ePWV quartile,the incidence density of diabetes showed an increasing trend,which was 5.84/1 000 person years,12.04/1 000 person years,15.70/1 000 person years and 16.87/1 000 person years,respectively.After adjusting for the traditional cardiovascular risk factors,the risk of new onset diabetes increased by 9%(HR=1.09,95%CI:1.08-1.11,P<0.01)for each 1 m/s increase in ePWV.Subgroup analysis showed that higher ePWV was significantly associated with increased risk of new-onset diabetes regardless of presence or absence of cardiovascular risk factors,male or female,and age<51 years or age≥51 years,with the HR(95%CI)values of 1.07(1.05-1.08)and 1.21(1.08-1.36),1.07(1.06-1.09)and 1.17(1.15-1.20),1.22(1.19-1.24)and 1.06(1.04-1.07). Conclusions:ePWV has a certain predictive value for new-onset diabetes and is an independent risk factor for new-onset diabetes.

Traumatic supraorbital fissure syndrome (TSOFS) is a symptom complex caused by nerve entrapment in the supraorbital fissure after skull base trauma. If the compressed cranial nerve in the supraorbital fissure is not decompressed surgically, ptosis, diplopia and eye movement disorder may exist for a long time and seriously affect the patients′ quality of life. Since its overall incidence is not high, it is not familiarized with the majority of neurosurgeons and some TSOFS may be complicated with skull base vascular injury. If the supraorbital fissure surgery is performed without treatment of vascular injury, it may cause massive hemorrhage, and disability and even life-threatening in severe cases. At present, there is no consensus or guideline on the diagnosis and treatment of TSOFS that can be referred to both domestically and internationally. To improve the understanding of TSOFS among clinical physicians and establish standardized diagnosis and treatment plans, the Skull Base Trauma Group of the Neurorepair Professional Committee of the Chinese Medical Doctor Association, Neurotrauma Group of the Neurosurgery Branch of the Chinese Medical Association, Neurotrauma Group of the Traumatology Branch of the Chinese Medical Association, and Editorial Committee of Chinese Journal of Trauma organized relevant experts to formulate Chinese expert consensus on the diagnosis and treatment of traumatic supraorbital fissure syndrome ( version 2024) based on evidence of evidence-based medicine and clinical experience of diagnosis and treatment. This consensus puts forward 12 recommendations on the diagnosis, classification, treatment, efficacy evaluation and follow-up of TSOFS, aiming to provide references for neurosurgeons from hospitals of all levels to standardize the diagnosis and treatment of TSOFS.

This article provides an overview of metaverse medicine and summarizes the challenges faced by cancer patients, the applications and effects of metaverse medicine in this population, and the limitations and difficulties in clinical practice. These challenges include legal and ethical restrictions, as well as the need for further validation of clinical acceptability and feasibility. Researchers are encouraged to conduct extensive studies to refine the legal and regulatory frameworks, enhance the safety and adoption of metaverse medicine, and facilitate its localized development in cancer care.

Objective:To investigate the application effects of nitrous oxide and oxygen mixed inhalation technology on analgesia and sedation during debridement and dressing change in children with moderate or severe burns.Methods:A retrospective non-randomized contemporary controlled study was conducted. From December 2019 to November 2021, 140 burn children with moderate or severe burns, aged 1 to 3 years, who met the inclusion criteria were admitted to Central Hospital Affiliated to Shandong First Medical University. During debridement and dressing change 3 to 14 days after injury, 42 children, including 23 males and 19 females, who received nurse-centered pain management mode and analgesia and sedation with nitrous oxide and oxygen mixed inhalation technology were included in nitrous oxide group (the dressing change process using the above-mentioned technology for the first time was selected for the follow-up study). Another 42 children, including 24 males and 18 females, were included in non-nitrous oxide group from 98 children who did not apply analgesia or sedation treatment during dressing change with stratified random sampling (one dressing change process was randomly selected for the follow-up study). The face, legs, activity, cry, and consolability scale and Ramsay sedation scale were used to evaluate the pain intensity and degree of sedation, respectively, at 30 minutes before dressing change (hereinafter referred to as before dressing change), immediately after debridement, and at 30 minutes after finishing dressing change (hereinafter referred to as after dressing change). After dressing change, the self-made satisfaction scale was used to evaluate the satisfaction degree of dressing change surgeons and guardians of children for analgesic effects during dressing change. The duration of dressing change and the healing time of deep partial-thickness burn wounds were recorded. The heart rate and percutaneous arterial oxygen saturation (SpO 2) before, during, and after dressing change and the occurrence of adverse events such as nausea and vomiting during dressing change were recorded. Data were statistically analyzed with Mann-Whitney U test, chi-square test, analysis of variance for repeated measurement, independent sample t test, and Bonferroni correction. Results:There were no significant differences in the score of pain intensity and score of sedation degree between children in two groups before and after dressing change ( P>0.05). Immediately after debridement, the score of pain intensity of children in nitrous oxide group was 2.5±0.7, which was significantly lower than 7.6±1.0 in non-nitrous oxide group ( t=-26.69, P<0.05); the score of sedation degree of children in nitrous oxide group was 1.83±0.38, which was significantly higher than 1.21±0.42 in non-nitrous oxide group ( t=7.15, P<0.05). After dressing change, the satisfaction degree scores of dressing change surgeons and guardians of children for analgesic effects during dressing change of children in nitrous oxide group were significantly higher than those in non-nitrous oxide group (with t values of 10.53 and 2.24, respectively, P<0.05). The dressing change duration of children in nitrous oxide group was significantly shorter than that in non-nitrous oxide group ( t=-5.33, P<0.05). The healing time of deep partial-thickness burn wounds in children between the two groups had no significant difference ( P>0.05). The heart rate of children in nitrous oxide group was significantly lower than that in non-nitrous oxide group during dressing change ( t=-12.40, P<0.05), while the SpO 2 was significantly higher than that in non-nitrous oxide group ( t=5.98, P<0.05). During dressing change, 2 children had nausea and 1 child had euphoria in nitrous oxide group, while heart rate of all children in non-nitrous oxide group continued to be higher than the normal range. Conclusions:In the process of debridement and dressing change in children with moderate or severe burns, the use of nurse-centered pain management mode and the standardized use of nitrous oxide and oxygen mixed inhalation technology can safely and effectively control pain and sedation.

Objective:To investigate predictive factors for successful endovascular recanalization in patients with non-acute symptomatic internal carotid artery occlusion (SICAO), to develop a decision tree model using the Classification and Regression Tree (CART) algorithm, and to evaluate the predictive performance of the model.Methods:Patients with non-acute SICAO received endovascular therapy at 8 comprehensive stroke centers in China were included retrospectively. They were randomly assigned to a training set and a validation set. In the training set, the least absolute shrinkage and selection operator (LASSO) algorithm was used to screen important variables, and a decision tree prediction model was constructed based on CART algorithm. The model was evaluated using the receiver operating characteristic (ROC) curve, Hosmer-Lemeshow goodness-of-fit test and confusion matrix in the validation set.Results:A total of 511 patients with non-acute SICAO were included. They were randomly divided into a training set ( n=357) and a validation set ( n=154) in a 7:3 ratio. The successful recanalization rates after endovascular therapy were 58.8% and 58.4%, respectively. There was no statistically significant difference ( χ2=0.007, P=0.936). A CART decision tree model consisting of 5 variables, 5 layers and 9 classification rules was constructed using the six non-zero-coefficient variables selected by LASSO regression. The predictive factors for successful recanalization included fewer occluded segments, proximal tapered stump, ASITN/SIR collateral grading of 1-2, ischemic stroke, and a recent event to endovascular therapy time of 1-30 d. ROC analysis showed that the area under curve of the decision tree model in the training set was 0.810 (95% confidence interval 0.764-0.857), and the optimal cut-off value for predicting successful recanalization was 0.71. The area under curve in the validation set was 0.763 (95% confidence interval 0.687-0.839). The accuracy was 70.1%, precision was 81.4%, sensitivity was 63.3%, and specificity was 79.7%. The Hosmer-Lemeshow test in both groups showed P>0.05. Conclusion:Based on the type of ischemic event, the time from the latest event to endovascular therapy, proximal stump morphology, the number of occluded segments, and the ASITN/SIR collateral grading constructed the decision tree model can effectively predict successful recanalization after non-acute SICAO endovascular therapy.

Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.

Objective:To analyze the clinical effect of small incision approach conjoint fascial sheath (CFS) suspension in the treatment of congenital severe blepharoptosis, and to discuss its advantages and disadvantages compared with conventional CSF suspension.Methods:From February 2020 to August 2022, 42 cases of severe blepharoptosis in the Department of Burn, Plastic and Cosmetic Surgery, Shaanxi Provincial People's Hospital were divided into the observation group (23 cases, 39 eyes) and the control group (19 cases, 37 eyes). The observation group was treated with small incision CFS suspension surgery, while the control group was treated with conventional CFS suspension surgery. The correction effect, complications, recovery time and other conditions between the two groups at different times after surgery were compared.Results:During postoperative follow-up at 1 week, 1 month, 3 months, and 6 months, there was no significant difference in the corrective effect between the two surgical methods at each time point (all P>0.05). The incidence of complications in the observation group at each time point that was 26.3%, 15.7%, 10.5%, and 5.2%, respectively, while the incidence of complications in the control group was 60.0%, 20.0%, 14.2%, and 8.6%, with statistical differences in the first week after surgery (χ 2=8.74, P=0.011). The average postoperative swelling time in the observation group was 4.2 days, which was less than 5.8 days in the control group. During a 6-month follow-up, it was found that there was a decrease in scar hyperplasia in the observation group of 9.1% (2/22) compared to the control group of 16.7% (3/18) (χ 2=0.023, P=0.878). The difference was of no statistical significance. Conclusions:CFS suspension with small incision in the treatment of moderate and severe blepharoptosis has the advantages of ideal correction effect, small damage range, and few postoperative complications, but the operation area is small, the operation is difficult, and the surgeon has higher requirements.