ObjectiveTo explore the effectiveness of feedforward control mode on improving occupational burnout among operating room nurses through theoretical research and clinical practice， with a view to promoting their physical and mental health and enhancing the quality of surgical nursing. MethodsA total of 440 operating room nurses from different regions， scales， and nursing experiences in Shaanxi Province from November 2023 to December 2023 were randomly divided into an experimental group and a control group， with 220 nurses in each group. While the control group received routine intervention measures， the experimental group introduced a feedforward control mode based on the control group， with “emotional exhaustion，” “depersonalization，”and“personal achievement” as observation indicators. ResultsThe incidence of occupational burnout in the experimental group was 11.4%， while that in the control group was 20.0%. The experimental group showed a significantly lower incidence than the control group （P=0.013）. ConclusionThe feedforward control mode can significantly alleviate nurses’ sense of job burnout， promote the improvement of surgical nursing quality， as well as continuously improve the scientific rigor， advancement， and humanistic nature of nursing services， which is conducive to building a harmonious and efficient nursing team. The spirit of teamwork， reflected in mutual support， mutual trust， and joint efforts for surgical success and patient health， has become an important component of nurses’ professional ethics.

BACKGROUND: Generalized pustular psoriasis (GPP), a rare and recurrent autoinflammatory disease, imposes a substantial burden on patients and society. Awareness of GPP in China remains limited. METHODS: This cross-sectional survey, conducted between September 2021 and May 2023 across 14 hospitals in China, included GPP patients of all ages and disease phases. Data collected encompassed demographics, clinical characteristics, economic impact, disease severity, quality of life, and treatment-related complications. Risk factors for GPP recurrence were analyzed. RESULTS: Among 127 patients (female/male ratio = 1.35:1), the mean age of disease onset was 25 years (1st quartile [Q1]-3rd quartile [Q3]: 11-44 years); 29.2% had experienced GPP for more than 10 years. Recurrence occurred in 75.6% of patients, and nearly half reported no identifiable triggers. Younger age at disease onset ( P  = 0.021) and transitioning to plaque psoriasis ( P  = 0.022) were associated with higher recurrence rates. The median diagnostic delay was 8 months (Q1-Q3: 2-41 months), and 32.3% of patients reported misdiagnoses. Comorbidities were present in 53.5% of patients, whereas 51.1% experienced systemic complications during treatment. Depression and anxiety affected 84.5% and 95.6% of patients, respectively. During GPP flares, the median Dermatology Life Quality Index score was 19.0 (Q1-Q3: 13.0-23.5). This score showed significant differences between patients with and without systemic symptoms; it demonstrated correlations with both depression and anxiety scores. Treatment costs caused financial hardship in 55.9% of patients, underscoring the burden associated with GPP. CONCLUSIONS The substantial disease and economic burdens among Chinese GPP patients warrant increased attention. Patients with early onset disease and those transitioning to plaque psoriasis require targeted interventions to mitigate the high recurrence risk.
Humans ; Male ; Female ; Psoriasis/pathology* ; Adult ; Cross-Sectional Studies ; Adolescent ; Child ; Young Adult ; Quality of Life ; Middle Aged ; China/epidemiology* ; Recurrence ; Risk Factors ; Surveys and Questionnaires ; East Asian People

ObjectiveBioinformatics methods were used to systematically identify the Salvia miltiorrhiza terpenoid synthase （SmTPS） gene family members and predict their functions from the perspective of the genome. MethodThe genome and transcriptome data of S. miltiorrhiza， Arabidopsis thaliana， and tomato were obtained from the national genomics data center （NGDC）， national center for biotechnology information （NCBI）， the Arabidopsis information resource （TAIR）， and tomato functional genomics database （TFGD）， and the whole genome identification and bioinformatics analysis of the SmTPS gene family member were carried out with the help of Perl language programming， Tbtools， and other bioinformatics tools. ResultA total of 52 TPS gene family members were identified， and they were distributed on eight chromosomes of S. miltiorrhiza. Their coding amino acid number was 207-822 aa. The isoelectric points were 4.76-9.16. The molecular mass was 24.11-94.81 kDa， and all members are hydrophilic proteins. Gene structure analysis showed that there were significant differences in the number of introns among different subfamilies. The number of introns in 72.6% of TPS-a， b， and g subfamilies was 6， and that in 88.9% of TPS-c and e/f subfamilies was more than 10. Protein motifs were conserved among TPS subfamilies. The analysis of promoter cis-acting elements showed that all promoters of the SmTPSs contained a large number of light-responsive elements， and most of them had hormone-responsive elements. Gene expression analysis showed that SmTPS gene family members exhibited tissue-specific expression， and 24 of them responded to exogenous methyl jasmonate. ConclusionBased on the published S. miltiorrhiza genome， 52 SmTPS gene family members were identified， and their functions were predicted based on the phylogenetic analysis and expression patterns. This paper provides reference information for the further biosynthesis pathway and regulatory mechanism analysis of terpenoids in S. miltiorrhiza.

Objective To analyze the serum levels of apurinic/apyrimidinic endonuclease 1 autoantibodies (APE1-AAbs) and growth differentiation factor 15 (GDF-15) and their predictive value for postoperative recurrence and metastasis in patients with colorectal cancer. Methods Fifty-two patients with colorectal cancer were selected as observation group, and were divided into postoperative recurrence and metastasis group (n=15) and non-recurrence and metastasis group (n=37) according to prognosis. Fifty-two healthy individuals undergoing routine physical examination during the same period were selected as the control group. The levels of APE1-AAbs and GDF-15 were measured. Pearson correlation analysis was used to analyze the correlations of APE1-AAbs, GDF-15 with post-surgical recurrence and metastasis of colorectal cancer. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of APE1-AAbs and GDF-15 for post-surgical recurrence and metastasis of colorectal cancer. Results The levels of APE1-AAbs and GDF-15 in the observation group were significantly higher than those in the control group (P < 0.05). The levels of APE1-AAbs and GDF-15 in the postoperative recurrence and metastasis group were significantly higher than those in the non-recurrence and metastasis group (P < 0.05). There was a positive correlation between the levels of APE1-AAbs, GDF-15 and post-surgical recurrence and metastasis of colorectal cancer (P < 0.05). The combined use of APE1-AAbs and GDF-15 had higher predictive value for post-surgical recurrence and metastasis of colorectal cancer than either single prediction (P < 0.05). Conclusion APE1-AAbs and GDF-15 are highly expressed in the serum of colorectal cancer patients. APE1-AAbs and GDF-15 may serve as markers for post-surgical recurrence and metastasis of colorectal cancer.

Objective:To evaluate partial ventral hepatectomy in the treatment of patients with complicated iatrogenic high bile duct injury.Methods:The clinical data of 8 cases of complicated iatrogenic high bile duct injury treated with the assistance of hepatic ventral segmentectomy from Mar 2013 to May 2020 at Hunan Provincial People's Hospital was retrospectively analyzed.Results:Among the 8 patients, 5 patients underwent partial Ⅳb lobectomy, and 3 patients received partial Ⅳb and Ⅴ segmentectomy of the liver. All the operation was successful without death in hospital. One case developed subphrenic infection and seroperitoneum, which was healed by anti-infection treatment and abdominocentesis. The postoperative follow-up time was 5-90 months, and all of patients are doing well. There was no stenosis in intrahepatic bile duct by postoperative cholangiography or MRI.Conclusions:Quadrate lobe hepatectomy provides a wide view for the treatment of complicated iatrogenic high bile duct injury by fully opening the first porta hepatis and exposing the primary and secondary bile duct branch helping establish a wide patent tension free bile duct-jejunostomy.

Objective:To investigate the effect of tegafur combined with oxaliplatin on the life cycle and serum alpha-fetoprotein (AFP) and carbohydrate antigen 242 (CA242) levels in patients with advanced gastric cancer.Methods:A total of 100 patients with advanced gastric cancer admitted to Hefei Third People′s Hospital from October 2016 to October 2019 were selected and divided into two groups according to randomization, with 50 cases in each group. The patients in the control group received calcium leucovorin and fluorouracil and oxaliplatin, and the patients in the observation group was treated with tegafur combined with oxaliplatin. The remission rate, disease control rate, median progression-free survival (PFS), median overall survival (OS), side effects and serum tumor markers AFP, CA242, carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA125), carbohydrate antigen 19-9 (CA19-9), tumor growth promoting indicators vascular endothelial growth factor (VEGF), matrix metalloproteinase (MMP)-2, MMP-9, insulin-like growth factor-1 (IGF-1), platelet endothelial cell adhesion molecule-1 (PECAM-1), microRNA (miR) 216a, miR95, miR4286 before and after treatment of the two groups were compared.Results:The remission rate in the observation group was higher than that in the control group: 42.0%(21/50) vs. 22.0%(11/50), and the difference was statistically significant ( P<0.05). After treatment, the levels of AFP, CA242, CEA, CA125, CA19-9 in the observation group were lower than those in the control group: (15.04 ± 3.65) μg/L vs. (20.65 ± 4.17) μg/L, (20.88 ± 6.37) kU/L vs.(35.46 ± 7.33) kU/L, (8.65 ± 2.13) μg/L vs.(15.39 ± 3.25) μg/L, (26.15 ± 8.49) kU/L vs. (34.16 ± 7.50) kU/L, (22.29 ± 5.80) kU/L vs. (38.81 ± 6.79) kU/L, and the differences were statistically significant ( P<0.05). The levels of VEGF, MMP-2, MMP-9, IGF-1 and PECAM-1 in the observation group were lower than those in the control group; the level of miR216a in the observation group was higher than that in the control group, and the levels of miR95 and miR4286 were lower than those in the control group, and the differences were statistically significant ( P<0.05). The median PFS in the control group was 3.0 months, the median OS in the control group was 6.6 months, the median PFS in the observation group was 3.3 months, the median OS in the observation group was 7.0 months, and the differences were no statistically significant ( P>0.05). The incidences of myelosuppression and skin damage toxicity in the observation group were lower than those in the control group: 6.0%(3/50) vs. 24.0%(12/50), 4.0%(2/50) vs. 18.0% (9/50), and the differences were statistically significant ( P<0.05). Conclusions:Tegafur combined with oxaliplatin in the treatment of advanced gastric cancer can improve the anti-cancer effect and promote the relief of the disease, and has high safety. The mechanism may be related to the inhibition of tumor growth promotion indexes and the regulation of miR.

Objective:To explore the feasibility and clinical effects of using free thinned deep inferior epigastric artery perforator flap to repair extensive soft tissue defects in extremities.Methods:From April 2010 to January 2014, 12 patients with extensive soft tissue defect in extremities after trauma, including 10 males and 2 females, aged 21 to 48 years, 6 patients with defect in the back of wrist and 6 patients with defect in ankle were admitted to the Department of Bone Microsurgery of Xi′an Honghui hospital. After debridement, the size of soft tissue defect ranged from 15.0 cm×4.5 cm to 28.0 cm×11.0 cm. The free thinned deep inferior epigastric artery perforator flap was designed, cut and transferred for reconstruction, with size of 15.0 cm×5.0 cm to 29.0 cm×12.0 cm. The flap thickness ranged from 4.0 to 6.5 cm before defatting, and was 0.6 to 0.9 cm after defatting. All the donor sites of flaps were closed directly by suturing. The flap survival and the appearance and function of flap and donor site were observed during follow-up.Results:All the flaps survived smoothly after surgery. During follow-up of 10 to 42 months, the flaps showed no bloat in appearance, no further flap revision or defatting procedures were required, the distance of static 2-point discrimination was 11 to 17 mm (14.5 mm on average). The abdominal function of patients was not affected, and no postoperative abdomen hernia or ulceration was noted.Conclusions:The free thinned deep inferior epigastric artery perforator flap is thin and suitable for repairing extensive soft tissue defects in extremities with very good outcomes.

Objective To discuss the anticoagulation effects and safety of sodium citrate in continuous renal replacement therapy (CRRT).Methods A total of 140 cases who underwent CRRT in the intensive care unit (ICU) of Zhejiang Provincial People′s Hospital from January 2014 to December 2016 were selected as research objects and divided into the heparin sodium group (n=56),the low molecular weight heparin calcium group (n=48) and the sodium citrate group (n=36) according to the anticoagulation methods. The differences of anticoagulation effects,the average service life of the pipelines,the overall pipeline quantity,the total cost of blood purification,the blood transfusion amount during CRRT,total bilirubin (Tbil),serum creatinine (Cer), Na+,K+,prothrombin time (PT),activated partial prothrombin time (APTT),platelet count (PLT) before and after CRRT and the complications related to CRRT among the three groups were compared.Results The anticoagulation effect of the sodium citrate group was obviously better than that of the other two groups (χ2=18.809,P<0.05). The average service life of the pipelines of the sodium citrate group was (29.3±5.4) h, which was obviously higher than that of the heparin sodium group (16.5±3.5) h and the low molecular weight heparin calcium group (24.8±4.1) h,and the intergroup difference was statistically significant (F=6.596, P<0.05). The transfusion amount of red blood cells,plasma and platelets of the sodium citrate group was (12.3±2.8) U,(1875.5±198.6) ml and (23.5±8.6) U,which was obviously lower than that of the heparin sodium group [(16.5±5.6) U,(2463.4±265.4) ml and (58.3±18.5) U] and the low molecular weight heparin calcium group [(13.4±3.2) U,(1954.4±214.5) ml and (32.6±11.5) U],and the intergroup differences were all statistically significant (F=4.563,3.896,7.456;P<0.05). The Tbil,Cer,Na+ and K+ of all groups decreased after CRRT,and the differences were all statistically significant (P<0.05). There were statistical significance in PT,APTT and PLT among the three groups (F=4.562,4.153,5.468;P<0.05). The PLT of the sodium citrate group increased significantly after CRRT,with statistical difference (P<0.05). The incidence rate of hemorrhages in skin,digestive tract,puncture point and trachea of the sodium citrate group was respectively 2.8％,5.6％,2.8％ and 5.6％,which was obviously lower than that of the heparin sodium group (23.2％,12.5％, 16.1％,12.5％) and the low molecular weight heparin calcium group (6.3％,10.4％,8.3％,8.3％),and the differences were all statistically significant (χ2=6.678,7.553,6.849,7.534;P<0.05). The incidence rate of heparin induced thrombocytopenia (HIT) of the heparin sodium group was 8.9％ (5/56).Conclusions The anticoagulation effect of sodium citrate in CRRT is remarkable with less complications. It can significantly reduce the amount of blood transfusion and the cost of blood purification and is worth of promotion in clinical application.

Objective To explore the curative effect of fibular flap with limbs composite soft-tissue.Methods From February,2013 to February,2016,13 cases with body severe trauma patients were treated,which including 5 cases of upper limbs and 8 cases of lower limbs,and all existed bone defect,soft tissue defect and trunk vessel defect.Three cases with limbs distal non blood supply were emergency treated with debridment and flow-through fibular flap transplantation renovation,peroneal artery repairing defective blood vesscls to rcstorc limbs distal blood supply,fibular flap repairing bone defect,skin flap repairing soft tissue defect.The limb blood supply for other 10 cases were in good condition,but one case with main artery defect did the second phase of fibular flap transplantation and repaired defective blood vessels,bone and skin soft tissue synchronously according to wound condition.According to the postoperative observation for flap survival and appearance,X-ray films to observe fracture healing after 6 weeks,three months and 6 months of operation as well as evaluating limb function recovery,then analyzed the results.Results Flaps survived successfully for 11 cases,and flaps for the other 2 cases were partial necrosis.One Case was edge flap necrosis,heal scabby after dressing,and the other case was necrosis for 1/3 of the area,but the deep fascia survival,and the skin graft healing after dressing.One case with forearm rolling was in vascular crisis after operation,but tbe crisis was relieved after detection,and fingers blood supply was recovered.All the patients were followed up for 6 to 36 months(mean,14 months).All flaps were survived,fractures healed well and limbs distal blood supply was good.Bone healing time was 8 to 24 weeks,and patients with lower limbs injury could bear load after 3 to 8 months.Lower limbs restored walking function.Upper limbs and hands restored rotation function.Transplant flapshad good elasticity and satisfactory appearance.Conclusion Using fibular flap to repair defective blood vessels,bone and soft tissue synchronously,not only can rescue the limbs on the verge of amputation,but also can repair defective composite tissue and get a good prognosis.It is an effective method for open injuries severely treatment in clinic.

Objective: To explore the clinical and molecular genetic features of a Chinese patient with catecholaminergic polymorphic ventricular tachycardia (CPVT). Methods: Clinical data including resting electrocardiography, echocardiography and treadmill exercise testing of a patient with CPVT admitted to our department in March 2013 were analyzed, and the peripheral venous blood samples of the patient and his family members and 400 ethnicity-matched healthy controls were obtained. All exons and exon-intron boundaries of the six CPVT-related genes including RYR2, CASQ2, TRDN, CALM1, KCNJ2 and ANKB were sequenced to detect the variants related to CPVT. The relationship between the genotypes and phenotypes was analyzed to direct the target therapy. Results: Recurrent syncope induced either by exercise or extreme frightened fear was observed in this patient. There was no positive family history of syncope or sudden death. The resting electrocardiography and echocardiography of the patient were normal, while the exercise testing revealed bidirectional and polymorphic ventricular tachycardia. A cardiac ryanodine receptor gene mutation (R2401H) was identified in this patient, while this mutation was absent in his parents and sister and 400 controls. No variant was detected in the remaining five candidate genes. Treatment with high dose of metoprolol succinate (118.75 mg/d) was effective and patient was free of syncopal attack during the 2 years follow-up. Conclusion This is the first report on RyR2-R2401H mutation in Chinese patient with CPVT, and high dose of metoptolol is the effective therapy option for CPVT related to RyR2 mutation.