Objective:To explore the chain mediating role of general self-efficacy and humanistic care competence between oncology nurses' empathy and medical narrative competence, with a view to informing the development of targeted medical narrative competence enhancement strategies.Methods:Convenience sampling was used to select 1 104 oncology nurses from 17 ClassⅢ Grade A hospitals in Yunnan Province from May to August 2023 for the study. The General Information Questionnaire, Narrative Competence Scale, Chinese version of the Jefferson Scale of Empathy, Caring Ability Inventory, and General Self-Efficacy Scale were used to survey oncology nurses. Pearson correlation was used to analyze the correlation among oncology nurses' general self-efficacy, empathy, humanistic care competence, and medical narrative competence. Mediating effects were analyzed using Model 6 in the SPSS macro program PROCESS 4.0 plug-in. Bootstrap method was used to repeat the sampling 5 000 times for the chained mediating effect test.Results:A total of 1 104 questionnaires were distributed and the number of valid questionnaires recovered was 931, with a valid recovery rate of 84.33% (931/1 104). Among 931 oncology nurses, the scores of Narrative Competence Scale, Caring Ability Inventory, Chinese version of Jefferson Scale of Empathy, and General Self-Efficacy Scale were (151.52±17.61), (191.68±18.80), (95.31±13.96), and (27.59±6.02), respectively. There was a positive two-by-two correlation among oncology nurses' medical narrative competence, empathy, humanistic care competence, and general self-efficacy ( P<0.01). General self-efficacy and humanistic care competence acted as chain mediators between oncology nurses' empathy and medical narrative competence, with the mediating effect accounting for 43.13% of the total effect. Conclusions:General self-efficacy and humanistic care are mediating variables between oncology nurses' empathy and medical narrative competence. Nursing managers should focus on the cultivation of nurses' empathy, stimulate nurses' self-efficacy, and promote the practice of nursing humanistic care, which in turn improves oncology nurses' medical narrative competence and the quality of nursing services.

Objective:To explore the chain mediating role of general self-efficacy and humanistic care competence between oncology nurses' empathy and medical narrative competence, with a view to informing the development of targeted medical narrative competence enhancement strategies.Methods:Convenience sampling was used to select 1 104 oncology nurses from 17 ClassⅢ Grade A hospitals in Yunnan Province from May to August 2023 for the study. The General Information Questionnaire, Narrative Competence Scale, Chinese version of the Jefferson Scale of Empathy, Caring Ability Inventory, and General Self-Efficacy Scale were used to survey oncology nurses. Pearson correlation was used to analyze the correlation among oncology nurses' general self-efficacy, empathy, humanistic care competence, and medical narrative competence. Mediating effects were analyzed using Model 6 in the SPSS macro program PROCESS 4.0 plug-in. Bootstrap method was used to repeat the sampling 5 000 times for the chained mediating effect test.Results:A total of 1 104 questionnaires were distributed and the number of valid questionnaires recovered was 931, with a valid recovery rate of 84.33% (931/1 104). Among 931 oncology nurses, the scores of Narrative Competence Scale, Caring Ability Inventory, Chinese version of Jefferson Scale of Empathy, and General Self-Efficacy Scale were (151.52±17.61), (191.68±18.80), (95.31±13.96), and (27.59±6.02), respectively. There was a positive two-by-two correlation among oncology nurses' medical narrative competence, empathy, humanistic care competence, and general self-efficacy ( P<0.01). General self-efficacy and humanistic care competence acted as chain mediators between oncology nurses' empathy and medical narrative competence, with the mediating effect accounting for 43.13% of the total effect. Conclusions:General self-efficacy and humanistic care are mediating variables between oncology nurses' empathy and medical narrative competence. Nursing managers should focus on the cultivation of nurses' empathy, stimulate nurses' self-efficacy, and promote the practice of nursing humanistic care, which in turn improves oncology nurses' medical narrative competence and the quality of nursing services.

Objective:To analyze and discuss the application value and teaching effect of simulate patients (SP)-assisted problem-based learning (PBL) combined with team-based learning (TBL) mode in pediatric first aid teaching, in order to provide a new reference for the reform of standardized residency training and teaching mode of pediatrics in the new era in China.Methods:A total of 103 residents who participated in the standardized training in the Department of Pediatrics of Hunan Children's Hospital from January 2018 to December 2020 were selected as the research objects, and they were divided into the control group (50 cases) and the experimental group (53 cases). The control group adopted the previous teaching mode of residents, while the experimental group adopted the SP-assisted PBL combined with TBL mode. In this study, SPSS 22.0 software was used for t test and chi-square test. Results:The examination scores of the experimental group in the theoretical knowledge of pediatric first aid, clinical thinking and skills, and application of pediatric first aid skills were higher than those in the control group [(86.98±3.42), (85.69±5.13), (89.62±4.75)] vs. [(77.23±4.16), (81.16±3.96), (76.54±5.78)], with statistically significant differences between the two groups ( P<0.05). The questionnaire survey showed that the clinical thinking and pediatric emergency skills, doctor-patient communication ability, teamwork ability and other aspects of the experimental group were significantly better than those of the control group ( P<0.05). Conclusion:The SP-assisted PBL combined with TBL mode can produce positive effects in the standardized residency training of pediatrics, which will help residents better master pediatric first aid skills, improve their clinical comprehensive capabilities, and be more conducive to improving the quality of pediatric residency training, which is worth promoting in the new era.

Objective:To observe the therapeutic effect of echinacoside (ECH) on liver injury and glucose metabolism disorder in sepsis rats induced by cecal ligation and puncture (CLP), and to explore its possible mechanism.Methods:Forty eight male Sprague Dawley (SD) rats were randomly divided into four groups: sham group (sham), model group (CLP), treatment group (CLP+ ECH) and inhibitor group (CLP+ ECH+ EX527). The sham group only received laparotomy, and the model group underwent CLP. The treatment group was intragastric administration of echinacea (30 mg/kg) every day after CLP modeling. The inhibitor group was injected with silence information regulator 1 (SIRT1) inhibitor EX527 (5 mg/kg) one hour before CLP, and then treated the same as the treatment group. Fasting blood glucose, insulin and serum biochemical indexes were detected in virous groups. The serum levels of interleukin (IL)-1 β, IL-6 and tumor necrosis factor-α(TNF-α) were detected by enzyme-linked immunosorbent assay (ELISA). 2′, 7′- dichlorofluorescein diacetate (DCFH-DA) staining was used to observe the production of reactive oxygen species (ROS) in liver tissue of rats in each group; hematoxylin-eosin (HE) staining was used to observe the pathological changes of liver tissue in each group; The expressions of SIRT1, glucose-6-phosphatase (G6Pase), phosphoenolpyruvate carboxykinase (PEPCK), phosphorylated signal transducers and activators of transcription 3 (p-STAT3) and phosphorylated protein ki-nase B(p-AKT) were detected by Western blot.Results:Compared with sham group, the levels of serum glucose, serum insulin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), ROS, IL-1β, IL-6 and TNF-α in model group increased, while the liver glycogen and survival rate decreased (all P<0.05). After echinacoside treatment, the serum glucose, serum insulin, ALT, AST, ROS , IL-1β, IL-6 and TNF-α levels decreased, and the liver glycogen and survival rate increased (all P<0.05); After SIRT1 inhibitor intervention, the levels of serum insulin, ALT, AST, IL-6 and ROS in the inhibitor group increased ( P<0.05). HE staining showed that there were infiltration and necrosis of inflammatory cells in the liver tissue of model group, and echinacoside could significantly reduce the focal and massive necrosis; Western blot showed that compared with the sham group, the expression levels of SIRT1, p-STAT3 and p-AKT protein in the model group decreased, while the expression levels of G6Pase and PEPCK protein increased ( P<0.05); After echinacoside treatment, the expression levels of SIRT1, p-STAT3 and p-AKT increased, while the expression levels of G6Pase and PEPCK decreased ( P<0.05). After SIRT1 inhibitor intervention, the expression of SIRT1, p-STAT3 and p-AKT protein decreased, and the expression of G6Pase and PEPCK protein increased in the inhibitor group ( P<0.05). Conclusions:Echinacoside is a potential therapeutic agent for sepsis associated liver injury and glucose metabolism disorders, which may play a role by targeting SIRT1 to activate STAT3 and AKT in the liver.

Objective:To investigate whether miRNA-296-5p can inhibit enterovirus 71 (EV71) virus replication in neural cells SK-N-SH by targeting the phosphatase and tensin homology deleted on chromosome 10 (PTEN)/phosphatidylinositol 3-kinase (PI3K)/serine/threonine kinases (AKT) signaling pathway.Methods:Serum samples were collected from patients with EV71 virus-infected hand-foot-mouth disease and normal physical examination, and the expressions of serum inflammatory factors procalcitonin (PCT), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) , interleukin-6 (IL-6), IL-1β, and IL-13 were detected by enzymelinked immunosorbent assay (ELISA). Human neuroblastoma SK-N-SH cells infected by EV71 virus in logarithmic growth phase were set up as control group, miRNA-296-5p mimic group and miRNA-296-5p inhibitor group. The transfection was carried out according to the Lipofectamine 2000tm cell transfection reagent. The expression of EV71-VP1 gene mRNA and protein and PTEN/PI3K/Akt signal pathway related molecules in three groups of cells was observed by real-time fluorescent quantitative polymerase chain reaction (qRT-PCR) and Western blot.Results:ELISA test results showed that the levels of serum inflammatory factors PCT, CRP, TNF-α, IL-1β, IL-6 and IL-13 in patients with EV71 virus-infected hand, foot and mouth disease were significantly higher than those in normal physical examination ( P<0.05). The results of qRT-PCR and Western blot showed that the mRNA and protein levels of mirna-296-5p and PTEN in SK-N-SH were significantly decreased after EV71 virus infection, while the mRNA and protein levels of EV71-VP1 and molecules related to PI3K/AKT signaling pathway were significantly increased ( P<0.05). The expression of PTEN was significantly increased in the miRNA-296-5p mimic group, and the expression of EV71-VP1 and the activation of the PI3K/AKT signaling pathway were inhibited, while the effect was reversed in the miRNA-296-5p inhibitor group ( P<0.05). Conclusions:MiRNA-296-5p inhibits the replication of EV71 virus in neural cells SK-N-SH by targeting the PTEN/PI3K/AKT signaling pathway, while reducing the cellular inflammatory response, targeting miRNA-296-5p and downstream PTEN/PI3K/AKT The signal pathway is expected to provide therapeutic targets and theoretical basis for the treatment of hand-foot-mouth disease caused by clinical EV71 virus.

Objective: To analyze the clinical features of acute liver failure in critically ill children, to investigate the risk factors affecting the prognosis of acute liver failure in critically ill children, and to provide evidence for clinical diagnosis and prognosis. Methods: The data of 85 children with acute liver failure who conformed to the diagnostic criteria from January 2011 to January 2017 at Hunan Children′s Hospital were analyzed.According to the prognosis of children with acute liver failure, all children were divided into the survival group (49 cases) and the death group (36 cases). Univariate and multivariate Logistic regression methods were used to analyze the risk factors affecting the prognosis of children with acute liver failure. Results: There were statistically significant differences of enzyme bile isolation[26.5% (13/49 cases) vs.55.6%(20/36 cases), χ²=7.361, P=0.007], hepatic encephalopathy [16.3%(8/49 cases) vs.38.9%(14/36 cases), χ²=5.507, P=0.019], total bilirubin [72.30(3.93-428.80) μmol/L vs.153.08(3.23-776.26) μmol/L, U=-2.283, P=0.027], albumin [35.02(22.89-45.30) g/L vs.28.90(18.30-40.26) g/L, U=4.640, P=0.000], alanine aminotransferase [1 626.10(23.01-9 518.41) U/L vs.533.08(7.02-5 163.83) U/L, U=2.992, P=0.004], aspartate aminotransferase [1 611.20(34.51-15 850.02) U/L vs.715.54(60.06-10 280.42) U/L, U=2.312, P=0.023], blood ammonia [71.02(16.04-148.56) μmol/L vs.81.02(33.04-274.02) μmol/L, U=-2.057, P=0.046], prothrombin time [23.10(13.61-81.23) s vs.33.91(12.62-84.57) s, U=-2.364, P=0.022], activated partial prothrombin time [52.91(4.02-181.02) s vs.67.35(31.20-180.02) s, U=-2.226, P=0.029], and end-stage liver disease model score [13.00(-9.00-52.00) score vs.27.50(-9.00-88.00) score, U=-3.082, P=0.003] in the children with acute liver failure between the survival group and the death group.Multivariate Logistic regression analysis showed that total bilirubin (OR=0.236, 95%CI: 0.059-0.946, P=0.041), albumin(OR=0.854, 95%CI: 0.746-0.976, P=0.019), enzyme bile separation (OR=1.063, 95%CI: 1.031-1.119, P=0.005) and hepatic encephalopathy (OR=1.439, 95%CI: 1.021-2.043, P=0.017) were risk factors for the prognosis of children with acute liver failure. Conclusions The level of the total bilirubin and the ratio of enzyme bile isolation and hepatic encephalopathy are positively correlated but the level of albumin is negatively correlated with the prognosis of critically ill children with acute liver failure.

Objective To explore the prevalence of depressive disorder in the Mosuo ethnic minority in Ninglang district,Yunnan Province.Methods By stratified random sampling,1 121 Mosuo subjects aged 15 or above were selected and assessed by the MINI-international neuropsychiatric interview according to the Structured Clinical Interview for DSM-V-TR Axis I Disorders-Patient Edition for mental disorders.Results The standardized time-point prevalence of major depressive disorder in Mosuo nationality was 1.74％,and 1.69％ (95 ％ CI =1.32％-2.15 ％) in males and 1.77％ (95 ％ CI =1.39％-2.15 ％) in females.There was no statistically significant difference in the prevalence of major depressive disorder between males and females (x2 =0.051,P＞0.05).The standardized time-point prevalence of dysthymic disorder in Mosuo nationality was 0.78％,and 0.66％ (95％ CI=0.54％-0.78％) in males and 0.88％ (95％ CI=0.74％-1.02％) in females (x2=1.232,P＞0.05).Those aged 40-54 years old had the highest adjusted prevalence of depressive episodes(1.48％ (95％CI=0.77％-2.18％)).Conclusion The prevalence of depressive disorder in Mosuo nationality is in a low level,and the middle-age Mosuo people has the highest time-point prevalence.

Objective To investigate clinical effect and safety of eccentric reamer technique foraminoplasty during percutaneous endoscopic lumbar discectomy for the treatment of lumbar lateral recess stenosis.Methods All of 45 cases diagnosed of lumbar lateral recess stenosis between Apr 2010 to Jun 2012 were analyzed in our study.Among these cases,28 cases were male and 17 were female.The age of enrolled cases was 39-62 years old and the average age was 49.23±23.96 years old.All the cases were one-level,25 cases in L4,5 and 20 cases in L5S1.All the patients underwent percutaneous endoscopic lumbar discectomy.During surgery,eccentric reamer technique was applied for foraminoplasty.Perioperative data included surgical segment,surgical duration and blood loss during surgery.Oswestry Disability Index (ODI) and Visual analogue scale (VAS) for lower back and leg pain were recorded for the evaluation of surgical effect.All the data were recorded before surgery,1 day,1 month after surgery and final follow-up.Recurrent lumbar disc herniation,spinal canal hematoma,intervertebral disc infection,nerve root injury and post-operative dysthesia (POD) were recorded for complications.Results All the cases finished surgery and none of the cases was changed to other surgery method and no other electronic drill were used in these patients.Surgical duration was 45-76 min and average time was 61.23± 13.89 min.Blood loss during surgery was 10-25 ml and average blood loss was 15.02±4.33 ml.Post-operative hospitalization days were 1-3 days and 2.80±1.57 days.The follow-up time was 60-84 months and the average time was 73.23±8.47 months.ODI in one-day after surgery was 9.34±6.54％,significantly lower than 68.06±24.14％ before surgery and no statistically change had been observed in one-month after surgery and final follow-up.The VAS for lower back was 1.54±0.97 in one-day after surgery,significantly lower than 3.57±3.12 before surgery.The VAS for leg pain was 1.14±0.79 in one-day after surgery,significantly lower than 6.24±2.35 before surgery.During follow-up,1 case suffered from recurrent lumbar disc herniation (2.22％) and no intervertebral disc infection,spinal canal hematoma and POD was observed.Conclusion Eccentric reamer technique foraminoplasty in percutaneous endoscopic lumbar discectomy is an effective and safe surgical method for the treatment of lumbar lateral recess stenosis.

Objective To study the distribution of Oncomelania hupensis snails in mountainous regions and the dynamic charaeteristics of the distribution.Methods An environment calledLanbaoclosed to Puge County.Sichuan Provinee WaS selected as the study field.Random sampling was designed to determine the investigation sites.The snails were collected and the hying snaila were identified by the method of dissection in the laboratory.The distribution of snails was analyzed by some statistical indices,such as mean,variance and so on.Then the negative binomial distribution.log-normal distribution and exponential distribution were fitted to the snail data by the method of maximum likelihood estimation to explore the snail distribution in different time.Results The negative binomial distribution was fitted well to the snail data in April,May,July,August,September,November in 2008,and no distribution was fined to the snail data in June,October.December in 2008 and February in 2009.Conclusions The distribution of Oncomelania hupensis in mountainous regions is not simple negative binomial distribution,but pwbably a dynamic process and an uncertain distribution.

Objective To analyze the concentration, distribution and decreasing trend of niclosamide in soil through soil heaping mixed with niclosamide and the effect of Oncomelania control, and to explore the appropriate dosage for the 'heaping' method. Methods The soil samples were collected from six groups in Tezi township, Puge county, Sichuan Province, and the dosages were 16, 8, 4, 2, 1 and 0 g/m~2, respectively. After ultrasonic extraction, centrifugence and concentration, the samples were finally determined by high-performance liquid chromatography (HPLC). The mortality rate of snails was observed after 3 days and 7 days. Results The standard error and range of niclosamide in soil were large. There was no significant difference in concentration of niclosamide between the surface layer and deep layer of soil (P>0.05). After 5 months, niclosamide still could be determined in groups of 4 g/m~2. The mortality rate of snails decreased as the concentration of niclosamide decreased (P<0.05). After 5 months, in the group of 4 g/m~2 dosage, the 3 and 7 days mortality rate of snails were 5.33% and 9.33% in the surface layer, higher than the control group (P<0.05). Conclusions The heaping method is an efficacious measure of controlling snails and its recommended dosage is 4 g/m~2.