ObjectiveTo understand the level of medical narrative competence among hospice care practitioners in Shanxi Province， explore its influencing factors， and provide references for carrying out targeted training and improving the medical narrative competence of the medical and nursing staff. MethodsUsing convenience sampling， a total of 102 medical and nursing staff from hospitals providing hospice care in Shanxi Province were recruited as the research subjects. Questionnaire surveys were conducted with the Self-Designed General Information Questionnaire and the Self-Rating Scale for Medical Narrative Competence as the research tools. Univariate analysis and multiple linear regression analysis were adopted to explore the level of medical narrative competence and its influencing factors among hospice care practitioners in Shanxi Province. ResultsThe total score of medical narrative competence among hospice care practitioners in Shanxi Province was （158.19±19.69）. The mean scores of all dimensions were ranked from the lowest to the highest as attention and listening， understanding and response， and reflection and representation. Univariate analysis demonstrated that working years in hospice care， daily communication frequency with patients， weekly communication duration， degree of colleague care， professional recognition， job satisfaction， and familiarity with narrative medicine constituted the influencing factors for the level of medical narrative competence among hospice care practitioners （all P<0.05）. Multiple linear regression analysis showed that working years in hospice care， degree of colleague care， and familiarity with narrative medicine had statistically significant effects on the medical narrative competence of hospice care practitioners （all P<0.05）. ConclusionAdministrators of hospice care should prioritize medical and nursing staff who lack familiarity with narrative medicine， have low degrees of colleague care， experience short working years， and possess low professional recognition and job satisfaction with hospice care work. Targeted training should be strengthened for these individuals to improve their medical narrative competence level， thereby enhancing the quality of hospice care services.

OBJECTIVE To formulate an expert consensus on the prevention and control of respiratory infectious diseases in railway stations and trains in China,and to standardize the prevention and control of respiratory infec-tious diseases in railway stations and trains scientifically.METHODS The government authorities organized multi-ple prevention and control experts from transportation,medical care and prevention fields to conduct in-depth re-search through methods such as meetings and on-site investigations,and combined with their practical experi-ence in this field to formulate this expert consensus.RESULTS In-depth studies were conducted on the prevention and control strategies,measures and emergency response system construction of respiratory infectious diseases in railway stations and trains,and this expert consensus was formed.CONCLUSION This expert consensus supple-ments improves the existing prevention and control system for respiratory infectious diseases in railway stations and trains,and provides an important reference basis for the prevention and control of respiratory infectious disea-ses in railway stations and trains.

OBJECTIVE To formulate an expert consensus on the prevention and control of respiratory infectious diseases in railway stations and trains in China,and to standardize the prevention and control of respiratory infec-tious diseases in railway stations and trains scientifically.METHODS The government authorities organized multi-ple prevention and control experts from transportation,medical care and prevention fields to conduct in-depth re-search through methods such as meetings and on-site investigations,and combined with their practical experi-ence in this field to formulate this expert consensus.RESULTS In-depth studies were conducted on the prevention and control strategies,measures and emergency response system construction of respiratory infectious diseases in railway stations and trains,and this expert consensus was formed.CONCLUSION This expert consensus supple-ments improves the existing prevention and control system for respiratory infectious diseases in railway stations and trains,and provides an important reference basis for the prevention and control of respiratory infectious disea-ses in railway stations and trains.

Objective:To analyze the clinical characteristics and all-cause mortality influencing factors of patients with Keshan disease.Methods:Clinical data of patients with Keshan disease from Keshan disease areas in Sichuan Province and Yunnan Province were collected and retrospectively analyzed for clinical characteristics and survival status during regular follow-up. According to the survival status of patients, the survey subjects were divided into a survival group and a death group. All-cause mortality (referring to the death caused by various reasons throughout the follow-up period) was used as the study endpoint. Kaplan-Meier (K-M) survival curve analysis and log-rank χ 2 test were performed, univariate and multivariate Cox regression analysis were used for all-cause mortality factor analysis. Results:A total of 176 patients with Keshan disease were collected, including 92 cases in Sichuan Province and 84 cases in Yunnan Province. Among all the patients, there were 105 males, accounting for 59.66%, and 71 females, accounting for 40.34%. The age was (53.89 ± 13.19) years old. Thirty-five cases died from all causes, with a mortality rate of 19.89%. There were significant differences in age ( t = 2.09, P = 0.038), New York Heart Association (NYHA) cardiac function grading (χ 2 = 14.62, P < 0.001) and ventricular premature contraction (χ 2 = 6.82, P = 0.009) between the survival group and the death group. K-M survival curve analysis showed that patients with Keshan disease complicated by premature ventricular contraction and high NYHA cardiac function grading (Ⅲ and Ⅳ) had higher all-cause mortality (log-rank χ 2 = 8.72, 22.49, P < 0.05). Univariate Cox regression analysis showed that NYHA cardiac function grading and ventricular premature contraction ( HR = 3.09, 2.71, P < 0.05) were predictive influencing factors for all-cause mortality in patients with Keshan disease. Multivariate Cox regression analysis showed that NYHA cardiac function grading ( HR = 6.57, P = 0.002) and ventricular premature contraction ( HR = 2.98, P = 0.050) were independent factors for all-cause mortality in patients with Keshan disease. Conclusions:Among 176 patients with Keshan disease, the number of patients with poor cardiac function (NYHA cardiac function grading Ⅲ and Ⅳ) and arrhythmia is high. NYHA cardiac function grading and ventricular premature contractions are independent influencing factors for all-cause mortality in patients with Keshan disease.

Objective:To analyze the clinical characteristics, prognosis and gene mutation in patients with dilated cardiomyopathy (DCM) in Keshan disease area of Sichuan Province, and to explore the risk factors for all-cause death in DCM patients.Methods:In June 2016, 55 DCM patients diagnosed at the local disease prevention and control center through clinical manifestations, electrocardiogram examination, and echocardiography were selected as the survey subjects in Mianning County, Liangshan Yi Autonomous Prefecture, and Renhe District, Panzhihua City, Keshan disease areas of Sichuan Province. Baseline clinical data were analyzed and long-term follow-up was conducted. The follow-up period ended June 15, 2021, with the endpoint of all-cause death. Univariate Cox regression was used to analyze the influencing factors of all-cause death in patients, and Kaplan-Meier (K-M) survival curve was used to analyze the survival time of patients. At the same time, peripheral venous blood was collected from 27 DCM patients. After separating white blood cells, DNA was extracted, and whole exome sequencing was performed to screen potential pathogenic genes.Results:Among the 55 DCM patients, 40 were males and 15 were females. The age was (54.09 ± 12.38) years old. The heart function classification of New York Heart Association (NYHA) was mainly grade Ⅱ and Ⅲ, accounting for 94.55% (52/55). The follow-up time for 55 DCM patients was (7.02 ± 2.96) years, and 17 patients experienced all-cause death, accounting for 30.91% (17/55), including 15 males and 2 females. Compared with the survival group, the death group had a lower incidence of syncope (χ 2 = 6.57, P = 0.010), but higher rates of bilateral lower limb edema (χ 2 = 6.43, P = 0.017), pulmonary congestion (χ 2 = 7.61, P = 0.006), intraventricular conduction block (χ 2 = 6.41, P = 0.011), and angiotensin-converting enzyme inhibitor (ACEI) use (χ 2 = 6.57, P = 0.010), as well as increased left ventricular diameter ( t = 2.36, P = 0.022). Univariate Cox regression analysis showed that bilateral lower limb edema [hazard ratio ( HR) = 4.61, P = 0.042] and intraventricular conduction block ( HR = 3.20, P = 0.019) were risk factors for all-cause death of DCM patients. The results of K-M survival curve analysis showed that patients with bilateral lower limb edema and intraventricular conduction block had higher all-cause death rates (log-rank χ 2 = 5.02, 6.24, P = 0.025, 0.012). Whole exome sequencing results showed that 4 patients were detected to carry pathogenic or suspected pathogenic gene mutations, with a positive rate of 14.81% (4/27), involving three genes: β-myosin heavy chain 7 (MYH7), calreticulin 3 (CALR3), and gelsolin (GSN). Conclusions:The all-cause death rate of DCM patients in the Keshan disease area of Sichuan Province is relatively high. Dead patients are prone to bilateral lower limb edema, pulmonary congestion, and intraventricular conduction block, as well as increased left ventricular diameter. Bilateral lower limb edema and intraventricular conduction block are independent predictive risk factors for all-cause death in DCM patients. MYH7, CALR3 and GSN are involved in the pathogenesis of DCM.

Objective:To study the safety and efficacy of laparoscopic cholecystectomy (LC) in treatment of T2a and lower stages of gallbladder carcinoma.Methods:A retrospective study was performed on patients who were diagnosed with gallbladder cancer and underwent surgical treatment from January 2016 to January 2021 at Hunan Provincial People's Hospital. These patients were divided into the simple treatment group and the radical treatment group based on the surgical methods used. The simple treatment group consisted of 64 patients who underwent LC for accidental gallbladder cancers. The radical treatment group consisted of 30 patients who underwent laparoscopic radical cholecystectomy (LRC). The baseline characteristic of the two groups of patients were matched in a 1∶1 ratio using propensity score matching. After matching, there were 26 patients in each of the 2 groups. There were 7 males and 19 females in the simple group, with mean ± s. d. age of (60.6±9.6) years. There were 8 males and 18 females, with mean ± s. d. age (60.9±9.1) years in the radical treatment group. Blood loss, operation time, postoperative hospital stay, biliary leakage, acute pulmonary embolism, and incisional infection were compared between the two groups.Results:In the simple group, the operative time was (78.7±62.9) min, intraoperative blood loss was (10.7±11.6) ml and postoperative hospital stay was (4.4±2.6) d. These results were significantly better than those in the radical group with operative time (298.7±101.3) min, intraoperative blood loss (161.9±96.7) ml and postoperative hospital stay (9.9±4.0) d (all P<0.05). There were no significant difference in the postoperative complications and disease free survival rates between the two groups (both P>0.05). Conclusion:LC was safe and effective for treatment of T2a and lower stages of gallbladder cancer, and it could achieve a similar disease-free survival rate as LRC.

Objective:To analyze the causes of postoperative stricture of biliary-enteric anastomotic for congenital choledochal cysts.Methods:These 28 patients underwent salvage operation on an average 15 years (0.2-25 years) after initial surgeries at the Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital from Jan 2014 to Jun 2018.Results:In 26 patients the biliary-enteric anastomotic stenosis was benign, and in 2 the stricture was caused by cancerration. In 26 cases the Roux-en-Y hepaticojejunostomy was redone,among them 8 cases underwent concurrent hepatectomy for a better exposure of the intrahepatic bile duct. In 2 cases the anastomotic stenosis was found to be caused by canceration with extensive intraabdominal metastasis ,an external drainage was adopted. There were no inhospital deaths, and no serious complications. The postoperative follow-up time was 6-67 months. Two cancerated patients died within half a year, and the remaining patients had no long-term complications.Conclusions:Biliary-enteric anastomotic stenosis is one of the serious complications in postoperative patients for congenital choledochal cysts. Hence a wide, tension free biliary-enteric anastomosis performed by a experienced hand is necessary.

Post-stroke cognitive impairment (PSCI) is a series of syndromes caused by stroke, involving impairment of one or more cognitive functions, such as attention, language function, executive function, visuospatial cognition, episodic memory and working memory, etc. The traditional treatment methods of PSCI include drug therapy and cognitive training. The treatment modalities are limited and the maintenance effect is not good. Therefore, an auxiliary treatment method is urgently needed to improve its therapeutic effect. Transcranial direct current stimulation (tDCS) is a safe and mature non-invasive brain stimulation technique, which generates weak direct current (1-2 mA) through electrodes placed on the scalp to change the resting membrane potential of neurons, regulate the excitability of the cerebral cortex, so as to achieve the purpose of treatment. This article reviews the effect of tDCS on PSCI, and hopes to provide reference and guidance for its rehabilitation treatment.

Objective:To investigate the clinical efficacy of perihilar surgical techniques for diffuse hepatolithiasis.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 122 patients with diffuse hepatolithiasis who were admitted to Hunan Provincial People's Hospital from January 2010 to December 2015 were collected. There were 39 males and 83 females, aged from 21 to 82 years, with a median age of 51 years. After perihilar hepatectomy, the first, second and third divisions of hepatic ducts were opened longitudinally. Strictures in the bile ducts were relieved by stricturoplasty and internal bile duct anastomosis, and stones were removed by multiple methods under direct vision. After resection of severe atrophic liver segment along the plane of hepatic atrophy or bile duct stricture, T-tube or hepaticojejunos-tomy was used for internal drainage. Observation indicators: (1) surgical situations; (2) stricture relief and stone removal. (3) Follow-up. Follow-up was conducted by Wechat, telephone interview or outpatient examination. Patients were followed up once every 3 months in the postoperative 1 year through liver function and abdominal B-ultrasound examination. Subsequently, liver function and abdominal B-ultrasound were reexamined once a year. Magnetic resonance cholangiopancreato-graphy and computed tomography were performed when cholangitis or stone recurrence was suspected to analyze stone recurrence and patient survival. The follow-up was up to July 2020. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were expressed as absolute numbers or percentages. Results:(1) Surgical situations: for the 122 patients, the operation time, hepatic portal occlusion time, volume of intraoperative blood loss, duration of postoperative hospital stay were (253±71)minutes, 15 minutes(range, 14?38 minutes), 200 mL(range, 100?1 100 mL), (12±5)days. Postoperative complications occurred to 40 of 122 patients. There were 9 cases of incision infection, 8 cases of bile leakage (5 cases of bile leakage at hepatic section, 3 cases of choledochojejunostomy leakage), 8 cases of septicemia, 7 cases of pleural effusion, 5 cases of abdominal abscess, 3 cases of liver failure, 1 case of biliary bleeding. Some patients had multiple complications. Among the 122 patients, 2 cases died after operation, including 1 case of postoperative liver failure and 1 case of disseminated intravascular coagulation caused by biliary-intestinal anastomotic leakage complicated with sepsis. Patients with bile leakage and abdominal abscess were improved after puncture and drainage under the guidance of B-ultrasound. Patients with cholangiojejunal anastomotic bleeding were embolized through the right hepatic artery. The other complications were improved after conservative treatment. (2) Stricture relief and stone removal: 85 of 88 patients with biliary stricture were relieved, with the stricture relief rate of 96.59%(85/88). Among the 122 patients, 103 cases had stones completely removed and 19 cases had residual stones. The immediate stone clearance rate was 84.43%(103/122). Of the 19 patients with residual stones, choledochoscopy was refused in 3 cases and choledochoscope lithotripsy was performed in 16 cases, of which 7 cases were removed and 9 cases were still residual stones. Of the 122 patients, 110 cases were finally removed stones, 12 cases were eventually residual stones, and the final stone clearance rate was 90.16%(110/122). (3) Follow-up: among the 122 patients, 120 cases including 110 cases with find stone removal and 10 cases with residual stones were followed up for (78±14)months. The 1-, 3, 5-year stone recurrence rates of 120 patients were 0.83%(1/120), 6.67%(8/120), 9.17%(11/120), respectively. The 1-, 3-, 5-year stone recurrence rates of 110 patients with final stone removal were 0, 5.45%(6/110), 5.45%(6/110), respectively. The number of cases with stone recurrence at postoperative 1-, 3- and 5-year of 10 patients with residual stones were 1, 2, 5 cases, respectively. Of 120 patients with follow-up, 1 case died of end-stage liver disease, and the other patients had good survival.Conclusion:Perihilar surgical techniques for diffuse hepatolithiasis is safe and effective.

Objective:To explore the relationship between learning motivation and professional identity of nursing students.Methods:A total of 1 538 undergraduate and specialized nursing students from a medical college in Shandong Province were investigated with general information questionnaire, occupational identity scale and learning motivation scale.Results:The total score of professional identity and learning motivation of nursing students was 57.54±12.89 and 119.92 ±22.03 all of which were at the middle level. There was a positive correlation between the total score and each dimension ( r=0.225-0.614, P<0.01). Conclusions:Nursing students' professional identity is positively correlated with their learning motivation. The stronger their learning motivation is, the higher their level of professional identity is. It suggests that nursing education and managers should pay attention to improving their learning motivation and establish a stable professional concept.