Objective:To explore the application effect of the modified presentation assimilation discussion combined with heuristic clinical medicine teaching in training of extracorporeal membrane oxygenation specialist nurses.Methods:The convenient sampling method was used to select 62 nurses who participated in training of extracorporeal membrane oxygenation specialist nurses in the Second Affiliated Hospital of Zhengzhou University from January to June 2023 as the research objects. A total of 30 nurses who participated in the 25th training session from January to March 2023 were selected as the control group, and 32 nurses who participated in the 26th training session from April to June 2023 were selected as the observation group. The control group received conventional training method, while the observation group received modified presentation assimilation discussion combined with heuristic clinical medicine teaching. The theoretical knowledge and operational skills of nurses, core competence of extracorporeal membrane oxygenation specialist nurses and training satisfaction were compared between the two groups after training.Results:After training, the scores of theoretical knowledge and operational skills, core competence of extracorporeal membrane oxygenation specialist nurses and training satisfaction in observation group were higher than those in control group, and the differences were statistically significant ( P<0.05) . Conclusions:The modified presentation assimilation discussion combined with heuristic clinical medicine teaching can improve the theoretical knowledge and operational skills of extracorporeal membrane oxygenation specialist nurses, and the nurses' training satisfaction is higher.

Objective To analyze the characteristics of time in range(TIR)and its relationship with oxidative stress(OS)and insulin resistance status(HOMA-IR)in patients with type 2 diabetes mellitus(T2DM)and sleep apnea-hypopnea syndrome(OSAHS).Methods According to apnea-hypopnea index(AHI),165 T2DM in patients were divided into simple T2DM group(AHI<5 times/h,n=43),T2DM combine OSAHS mild group(OSAHS-G,5≤AHI<15 times/h,n=51),T2DM combined OSAHS moderate group(OSAHS-M,15≤AHI≤30 times/h,n=40)and T2DM combine OSAHS severe group(OSAHS-S,AHI>30 times/h,n=31).TIR was calculated by dynamic blood glucose monitoring.Superoxide dismutase(SOD),glutathione peroxidase(GSH-Px)and other indexes were detected and analyzed.Results Compared with simple T2DM group,the levels of HOMA-IR,8-iso-PGF2a and Ox-LDL were higher in T2DM combined OSAHS-G,OSAHS-M or OSAHS-S group,while the levels of TIR,SOD and GSH-Px were lower(P<0.05).Pearson correlation analysis showed that TIR was positively correlated with the levels of SOD and GSH-Px(P<0.05 or P<0.01),and negatively correlated with the levels of 8-iso-PGF2a,Ox-LDL,HbA1c,HOMA-IR and the severity of OSAHS(P<0.01).Logistic regression analysis showed that TIR,SOD and GSH-Px were protective factors for severe OSAHS in T2DM patients,while 8-iso-PGE2a and Ox-LDL were the risk factors for severe OSAHS.Conclusions The glucose level fluctuates greatly in patients with T2DM and OSAHS.Insulin resistance and oxidative stress are factors that affect the normalization of TIR.

Objectives:This study was aimed to investigate the risk factors for moderate and severe acute kidney injury(AKI),in-hospital mortality and dialysis dependence after acute Stanford type A aortic dissection(TAAD)surgery. Methods:Complete clinical data of 294 TAAD patients who underwent ascending aorta replacement,total aortic arch replacement combined with frozen elephant trunk between December 2014 and December 2016 with time between symptom onset and diagnosis<14 days were retrospectively and consecutively collected and analyzed.AKI was defined according to the SCr component of the Kidney Disease Improving Global Outcomes(KDIGO)2012 consensus criteria,and classified as moderate-severe AKI(AKI stage 2-3)or non-moderate-severe AKI(no AKI or AKI stage 1).Univariate and multivariate logistic regression analyses were used to analyze the risk factors for moderate to severe AKI,in-hospital mortality or dialysis dependence after TAAD surgery. Results:AKI occurs in 232 out of 294 patients(79.3%),124(42.2%)with AKI stage 1,45(15.3%)with AKI stage 2,63(21.4%)with AKI stage 3,and 27(9.2%)requiring continuous renal replacement therapy(CRRT).The dialysis dependence rate at discharge was 3.1%(n=9),and overall in-hospital mortality rate was 3.7%(n=11).Univariate analysis revealed that patients who developed the moderate-severe AKI were more likely to present with hypertension,preoperative renal hypoperfusion,longer duration of cardiopulmonary bypass(CPB),longer duration of aortic cross-clamp and higher intraoperative ultrafiltration volume(all P<0.05).Multivariate logistic regression analysis showed that renal hypoperfusion(OR=4.95,95%CI:1.97-12.26,P<0.001),and prolonged CPB time(OR=1.01,95%CI:1.00-1.02,P=0.016)were independent risk factors for moderate-severe AKI after TAAD surgery.Further analysis revealed that prolonged CPB time(OR=1.02,95%Cl:1.01-1.03,P=0.007)and moderate-severe AKI(OR=10.49,95%Cl:1.22-90.62,P=0.033)were independent risk factors for in-hospital mortality or dialysis dependence after TAAD surgery. Conclusions:Preoperative renal hypoperfusion and prolonged CPB time are independent risk factors for moderate-severe AKI after TAAD surgery.Prolonged CPB time and occurrence of moderate to severe AKI significantly increase the risk of in-hospital mortality and dialysis dependence,indicating that close clinical follow-up of these patients is required.

Objective To explore the effect of aerobic exercise on renal function abnormalities and mitochondrial oxidative stress of obese rats.Methods Ninety 5-week male Sprague-Dawley rats were randomly divided into a normal diet group(CON,n=10)and a high-fat diet group(n=80).The latter group was on high-fat diet for 8 weeks to induce obesity with renal function abnormality.After success-ful modelling,40 rats were chosen and randomly divided into a high-fat diet control group(HFD)and three groups of high-fat diet+aerobic exercise with different intensities(40%VO2max,60%VO2max,and 80%VO2max),each of 10.All exercise groups underwent daily 60-min aerobic exercise on treadmill,5 days per week for 4 weeks.After the intervention,their body weight,body length,perirenal and epi-didymal fat weights were measured,and morphometric indices including fat-body ratio and Lee's in-dex were calculated.Moreover,such biochemical indicators of renal function as serum creatinine(SCr),serum cystatin C and urinary microalbumin(mALB)were tested.Meanwhile,the pathological changes of the kidney were observed using hematoxylin eosin(HE)staining and Periodic acid-Schiff(PAS)staining,while the ultrastructural changes of the kidney and mitochondria were observed using the transmission electron microscopy.Moreover,the levels of superoxide dismutase(SOD),malondialde-hyde(MDA),and mitochondrial membrane potential in mitochondria were evaluated using ELISA kits.Results After 4 weeks of intervention,the average SCr,serum cystatin C,and mALB levels in the HFD group increased significantly compared with the CON group(P<0.05).Moreover,the average SCr levels of all exercise groups were significantly lower than the HFD group(P<0.05),with the average serum cystatin C and mALB levels of the 60%VO2max and 80%VO2max groups significantly lower than the HFD group(P<0.05).Meanwhile,the renal tubular epithelial cells in the HFD group showed mod-erate degeneration and increased glomerulosclerosis index(GSI)(P<0.05)and the degree of glomerular hypertrophy in each exercise group was significantly lower than the HFD group,with the renal tubules of the 60%VO2max group showing a clearer contour and decreased GSI(P<0.05).What's more,com-pared with the CON group,the number of swollen mitochondria in the HFD group increased,but the mitochondria damage of the 60%VO2max group relieved significantly compared with the HFD group.The renal mitochondrial MDA levels in the CON group increased significantly compared with the HFD group(P<0.05),and those of the exercise groups were significantly lower than the HFD group(P<0.05),with the most significant decrease in the 40%VO2max group(P<0.05).Moreover,the average renal mito-chondrial SOD and membrane potential levels in the HFD group decreased significantly compared with the CON group(P<0.05),while those in the 40%and the 60%VO2max groups were significantly higher than the HFD group(P<0.05).Conclusion Moderate to low intensity aerobic exercise can relieve renal dysfunction of obese rats by lowering the level of oxidative stress in renal mitochondria,mainly down-regulating such renal function biochemical indicators as SCr,serum cystatin C,and mALB,as well as alleviating the degree of renal tissue damage.

To investigate the prevalence and epidemiological characteristics of diabetic retinopathy (DR) in Yunnan Province, explore its risk factors, and provide a basis for the prevention and treatment of chronic complications of diabetes mellitus (DM). This is a large cross-sectional study, in all, 1 524 DM patients in 16 communities and villages of Yunnan Province who were registered in health service centers were included in this study from August to November 2019. All patients completed a uniform questionnaire, anthropometric measurements, biochemical measurements, and auxiliary examinations. Logistic regression analysis was used to screen the risk factors of DR. The prevalence rates of DR, mild non-proliferative DR (mild-NPDR), and referable DR (RDR) were 16.0% (244/1 524), 4.5% (69/1 524), and 11.5% (175/1 524), respectively. Glycated hemoglobin A 1c (HbA 1c)≥7.0% was the risk factor of mild-NPDR ( OR=1.872, 95% CI 1.055-3.323) and RDR ( OR=4.821, 95% CI 2.917-7.969). Blood pressure≥130/80 mmHg (1 mmHg=0.133 kPa) was the risk factor of mild-NPDR ( OR=1.933, 95% CI 1.112-3.358) and RDR ( OR=1.505, 95% CI 1.063-2.130). In Yunnan Province, 16.0% DM patients had accompanying DR, wherein about 71.7% of them required an ophthalmology referral, and the high incidence of RDR in DM patients was associated with poor control of blood glucose and blood pressure.

OBJECTIVE To correctly identify and deal with the adverse drug reaction as pancytopenia caused by isavuconazonium and to provide reference for the safe use of isavuconazonium. METHODS Clinical pharmacists analyzed a case of severe infection and renal insufficiency who experienced pancytopenia after using isavuconazonium. Clinical pharmacists screened the drugs used during hospitalization and evaluated the relationship between this adverse drug reaction and isavuconazonium， as well as the possible mechanisms， based on the half-life of the drugs and relevant literature. RESULTS & CONCLUSIONS The relationship between pancytopenia and isavuconazonium was assessed as “possibly related”. When using isavuconazonium， attention should be paid to avoiding the combination of drugs with the same mechanism or potential interaction. For patients who have a course of treatment for more than 2 weeks， have hematological abnormalities or complicated with liver and renal insufficiency， or should use it combined with other drug with same mechanism， it may be considered to increase the frequency of blood routine monitoring.

Foot ulcer prevention plays a crucial role in reducing the amputation rate among diabetic patients. With regard to the prevention of diabetic foot ulcers, the 2023 guidelines of the International Working Group of Diabetic Foot(IWGDF) were different from the 2019 counterpart. The most notable change is the addition of high-level evidence to support recommendations, primarily derived from randomized controlled studies. The 2023 guidelines also advocate for local skin temperature measurement, participation in ankle exercise training, and psychological intervention for foot ulcer prevention. This article conducts a comparative analysis of the two guidelines across six key dimensions: identification of high-risk feet, regular examination of high-risk feet, health education, ensuring appropriate daily footwear, addressing ulcer risk factors, and comprehensive foot care. Drawing from clinical insights, the application and prospective implications of the 2023 guidelines in China are also examined.

OBJECTIVE To explore the new idea of creating pharmaceutical science popularization oriented by internet medication consultation questions， and provide references for pharmacists to create high-quality pharmaceutical science popularization articles. METHODS By taking the internet medication consultation questions from September 1st， 2021 to February 28th， 2022 in a hospital as samples， pharmaceutical science popularization were created by using the Pareto chart for summarizing and analyzing the demands of the public pharmaceutical knowledge. The readers and creating cycle of pharmaceutical science popularization before and after the implementation of this method were compared by statistical analysis. RESULTS According to the Pareto principle， the types of consultation questions were mainly concentrated on usage and dosage， adverse reactions， and precautions； the types of drug consultation were mainly concentrated on respiratory system medications， anti-infective drugs， rheumatic immune system medications， and orthopedic medications， etc. Fifteen topics of science popularization were identified. Among them， 5 were published before 2022 and did not adopt the Pareto chart method， serving as the pre-method and consistent with the target theme group （A group）； 10 were published in 2022 after adopting the Pareto chart method， serving as the post- method group （B group）； 5 articles published before 2022 were selected randomly， without adopting the Pareto chart method and inconsistent with the target theme， serving as the pre-method and inconsistencies with the target theme group （C group）. Compared with the A group and the C group， the creating cycle of pharmaceutical science popularization in the B group was significantly reduced. Compared with the C group， the readers were significantly increased in the A group and the B group. CONCLUSIONS Pareto chart could help pharmacists utilize medication consultation questions to identify the pharmaceutical science popularization needed by the public， which could improve the efficiency and quality of creating pharmaceutical science popularization by pharmacists.

Purpose To investigate the expression of fork-head box protein A1(FOXA1)in esophageal squamous cell car-cinoma(ESCC)and its association with clinicopathologic char-acteristics and prognosis.Methods Immunohistochemistry was used to detect FOXA1 protein expression in 532 cases of esopha-geal squamous cell carcinoma.The correlation between FOXA1 protein expression and clinicopathologic features and prognosis of patients was analyzed.Results In 532 cases of esophageal squamous cell carcinoma,183 cases overexpressed FOXA1 pro-tein(34.4％).FOXA1 overexpression was associated with ES-CC vascular infiltration(P=0.032),poorly differentiation(P=0.032),and tumor size(P＜0.001).The overall survival(OS)and disease free survival(DFS)of patients with stage Ⅰ+Ⅱ esophageal squamous cell carcinoma with high FOXA1 ex-pression tended to be poor(OS:P=0.094;DFS:P=0.107).In ESCC patients with survival longer than 24 months,the high FOXA1 expression group had significantly shorter OS and DFS(OS:P=0.048;DFS:P=0.047).Multivariate survival anal-ysis showed that the depth of tumor invasion was an independent prognostic factor affecting the prognosis of esophageal squamous cell carcinoma.Conclusion FOXA1 is overexpressed in e-sophageal squamous cell carcinoma,and its high expression is related to tumor size,vascular infiltration and poorly differentia-tion.Patients with high FOXA1 expression tended to have poor prognosis in OS and DFS.When OS and DFS≥24 months,high FOXA1 expression may be used as a reference indicator for poor prognosis in ESCC patients.

Background Healthcare workers suffer from great internal and external pressure and are prone to burnout. Existing studies have shown that depressive symptoms are important influencing factors of burnout, both of which are closely related to job stress. Objective To analyze overall prevalence of burnout among healthcare workers using a new survey tool developed by our team, and to reveal potential influencing factors related to burnout. Methods A cross-sectional multi-center study was conducted in August–October 2019 and June–September 2020, using multi-stage stratified cluster sampling. A total of 8738 healthcare workers from 22 hospitals in 5 provinces (Shandong, Hubei, Hunan, Guangdong, and Chongqing) of China were selected in this study. A set of survey questionnaires, including the general information questionnaire and the Chinese versions of General Burnout Scale, Core Occupational Stress Scale, Patient Health Questionnaire-9, and Self-administered Sleep Questionnaire were distributed. Independent samples t-test or one-way ANOVA were employed for inter-group comparison of burnout. Spearman correlation was used to evaluate correlations among burnout, depressive symptoms, and occupational stress. Stepwise linear regression was conducted to identify factors independently associated with burnout. Process plug-in was used to test potential mediating effect of depressive symptoms on occupational stress and burnout. Results Of the 8738 questionnaires distributed, 8456 valid questionnaires were collected, and the recovery rate was 96.77%. Among the 8456 healthcare workers, the prevalence of burnout was 58.0%, that of occupational stress was 31.8%, and that of depressive symptoms was 31.0%. Among those with depressive symptoms and occupational stress, the proportions of burnout were 86.7% and 83.7%, respectively. According to the stepwise linear regression analysis, depressive symptoms, occupational stress, work experience, drinking, and marital status were all independent influencing factors of burnout. Especially, depressive symptoms, social support, and organization and reward had significant influences on burnout (b'=0.455, −0.183, 0.220, P<0.001). Depressive symptoms showed mediating effects on occupational stress (and its subscales) and burnout, and the contribution rates of the mediating effects were 41.00%, 47.02%, 43.44%, 56.62%, and 59.45%, respectively. Conclusion Burnout is a prominent problem among healthcare workers in the 5 provinces, with the prevalence of 58.0%. And nearly 1/3 suffering from depressive symptoms and occupational stress, which has a great impact on burnout.