OBJECTIVE To provide references for the accurate identification and management of immune-related cutaneous adverse events （irCAEs） caused by durvalumab， and ensuring safe clinical drug use. METHODS Clinical pharmacists participated in the diagnosis and treatment process of a patient with gallbladder cancer who developed irCAEs caused by durvalumab. The clinical pharmacists systematically reviewed the patient’s past medical history and medication history， and assisted physicians in assessing the association between adverse drug reactions and administered drugs. Meanwhile， the clinical pharmacists conducted a graded assessment of the adverse reaction， proposed recommendations such as discontinuing durvalumab and adjusting the administration regimen of glucocorticoids， assisted physicians in restarting immunotherapy， and carried out medication education and other pharmaceutical care. RESULTS The occurrence of irCAEs in this patient was “highly likely” related to durvalumab and was classified as severe. The physicians adopted the clinical pharmacist’s opinion， and after symptomatic treatment， the patient’s skin symptoms improved， and discharged with medication. After the completion of glucocorticoid therapy for the patient， the physician restarted immunotherapy with tislelizumab， and no related adverse reactions occurred again in the patient. CONCLUSIONS Durvalumab can cause irCAEs such as severe skin maculopapular rash. In clinical practice， it is crucial to promptly identify and discontinue suspicious drugs， immediately implement effective symptomatic treatment measures， and actively resume immunotherapy to ensure the continuity and safety of the patient’s treatment.

Objective:To analyze the application effect of small private online course (SPOC)-based maker education in oncology surgical nursing teaching.Methods:This study enrolled 105 nursing students who completed their internship in the Department of Oncology Surgery from January 2022 to September 2023. The subjects were divided into control group ( n=52, conventional teaching) and observation group ( n=53, SPOC-based maker education) according to their admission order. Before and after teaching, students were evaluated on the theoretical knowledge, operational skills, nursing practice ability, innovation ability, self-learning ability, professional identity, and teamwork ability. The Medical Education Satisfaction Scale (MESS-21) was used to evaluate teaching outcomes. Data were analyzed using the t-test and chi-square test with SPSS 25.0. Results:After teaching, the observation group had higher scores than the control group in theoretical knowledge [(93.60±12.53) vs. (85.90±10.49)], operational skills [(92.63±12.40) vs. (83.75±10.27)], nursing practice ability [(93.50±12.81) vs. (84.72±11.43)], and innovation ability [(91.68±12.53) vs. (80.20±8.37)]; this was also true for learning motivation [(16.63±4.76) vs. (12.90±3.85)], planning and implementation [(16.83±4.77) vs. (13.54±4.32)], self-management [(15.49±4.60) vs. (13.42±4.13)], interpersonal communication [(14.74±4.53) vs. (11.77±3.59)], POIS-M score [(84.61±8.84) vs. (63.53±6.48)], and T-TAQ score [(53.90±5.07) vs. (46.75±4.02)] (all P<0.05). The observation group also had significantly higher scores than the control group in clarity of teaching objectives [(13.58±3.47) vs. (9.14±2.66)], practicality of teaching content [(13.50±3.69) vs. (10.62±2.81)], and supportiveness of teaching resources [(13.92±3.58) vs. (8.88±2.34)]. Conclusions:SPOC-based maker education offers significant advantages in oncology surgical nursing teaching. It effectively enhances nursing students' theoretical knowledge, operational skills, nursing practice ability, innovation ability, self-learning ability, professional identity, and teamwork ability and it is highly valued by students. Its novelty and effectiveness provide new ideas for oncology surgical nursing teaching.

Objective To investigate the correlation between early clinical outcomes following endoscopic surgery for unilateral lumbar disc herniation and variations in the cross-sectional area of the sciatic nerve.Methods Fifty-two patients(n=52)with unilateral lumbar disc herniation were recruited from June 2023 to June 2024 at the Pain Department of the First Affiliated Hospital of Nanchang University.The cross-sectional area(CSA)values of bilateral sciatic nerves were measured at the gluteal sciatic tuberosity-great femoral rotor level using ultrasound before and on the 4th day after surgery.The change in nerve cross-sectional area ΔCSA and sciatic nerve swelling rate(SR-SN)were calculated.Patient BMI(Body Mass Index),visual analog scale(VAS),Japanese Orthopaedic Association score(JOA),Oswestry Disability Index(ODI),and Treatment Improvement Rate(TIR)were collected preoperatively and on postoperative day 4.Changes in sciatic nerve cross-sectional area in unilateral lumbar disc herniation and its relationship to clinical outcomes were analyzed using the scoring scales as controls.Results Compared to the preoperative period,there was a significant decrease in VAS and ODI scores,as well as an increase in JOA score on the 4th postoperative day(P<0.01).Furthermore,surgical intervention led to substantial improve-ment in clinical outcomes for the patients.Prior to surgery,the CSA value of the affected side of the sciatic nerve was greater than that of the healthy side(P<0.01).Although CSA value decreased on the affected side after surgery,it remained higher than that of the healthy side(P<0.01).Additionally,there was a significant difference between SR-SN values on both sides with higher values observed on the affected side(P<0.01).Notably,△CSA on the affected side exhibited a negative correlation with postoperative VAS score,JOA score,and treatment improvement rate(P<0.05);The SR-SN on the affected side exhibited a positive correlation with BMI and negative correlations with postoperative VAS score,JOA score,and treatment improvement rate(P<0.05).However,no significant correlations were observed between △CSA,SR-SN,and ODI score on the affected side.(P>0.05).Conclusions In patients undergoing endoscopic surgery for lumbar disc herniation,a greater change in the cross-sectional area of the affected sciatic nerve before and after the operation is associated with more pronounced improvement in early symptoms.However,further investigation is required to explore the relationship between this change and recovery of both lumbar spine and lower limb function.

Objective:To explore the dilemmas in the discharge preparation process of postoperative breast cancer patients within the framework of Meleis' Transition Theory, and to provide evidence for the development of nursing interventions to improve discharge readiness.Methods:This was a qualitative study. Using purposive sampling, postoperative breast cancer patients hospitalized in the Department of Breast Surgery of Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University between September and October 2024 were selected for the study. Semi-structured, in-depth interviews were conducted. Data were analyzed and themes extracted using Colaizzi's seven-step analysis method.Results:A total of four themes were extracted: personal status-patients experienced complex emotions at discharge; disease knowledge preparation-patients had insufficient mastery of relevant knowledge after discharge; coping ability-patients lacked confidence in home self-care after returning home; social support-patients desired support from peers and medical staff.Conclusions:Postoperative breast cancer patients face multiple dilemmas during discharge preparation. Medical staff are advised to pay attention to the psychological status of discharged patients and develop individualized emotional coping strategies; provide professional information and meet patients' fertility and sexual health knowledge needs; optimize health education models to enhance patients' home coping ability; and strengthen the integration of mobile health with nursing practice to build a multidimensional support system.

Objective To evaluate the impact of integrated medical and nursing care teaching ward rounds on the theo-retical knowledge learning and clinical operational skill training of primary-level medical staff.Methods A total of 90 clinical healthcare workers(39 physicians and 51 nurses)from our hospital between May and December2024 were randomly assigned to either a control group or an intervention group.The control group participated in traditional three-tier nursing teaching ward rounds,while the intervention group underwent integrated medical and nursing care teaching ward rounds.The two groups were compared in terms of improvements in theoretical knowledge,ward round operational skills,and core clinical competencies.Re-sults Both groups demonstrated improvements in theoretical knowledge and ward round operational skills after the intervention,with the intervention group showing significantly greater gains(P＜0.05).Additionally,scores related to physical fitness,emo-tional well-being,and cognitive function improved in both groups,with significantly higher improvements in the intervention group(P＜0.05).The Clinical Nursing Skills(CINS)scores—including judgment,early warning,anticipatory thinking,and overall clinical competence—also improved significantly in the intervention group compared to the control group(P＜0.05).Conclu-sion Integrated medical and nursing care teaching ward rounds significantly enhance theoretical knowledge,operational profi-ciency,and core clinical competencies among primary healthcare providers.This model fosters higher professional engagement and helps cultivate qualified primary-level medical personnel who are better equipped to meet real-world clinical demands.

This article focuses on the deepening and innovation of grassroots party building work in public hospitals,tak-ing Sijing Hospital in Songjiang District,Shanghai as a case study.It explores how public hospitals can improve service quality and promote high-quality development through party building work in the new era.By analyzing the main problems faced by party building work,this article proposes practical paths for innovative party building work,including establishing a party building grid management organizational framework,formulating and improving party building management standards and systems,standardi-zing party building project processes,and strengthening party building assessment and supervision.Through the deepening and innovation of party building work,the integration of party building work and hospital business is achieved,thereby enhancing the overall service capacity and management level of the hospital,cultivating high-quality medical and health personnel,and provi-ding solid political guarantees and organizational support for the sustainable development of public hospitals.

Objective:To investigate the safety and efficacy of urinary microbiota transplantation（UMT）in treating interstitial cystitis（IC）.Methods:A retrospective analysis of the clinical data of three patients with IC treated with UMT at the Central Hospital of Jiangnan University from May 2022 to August 2024. Three women（45，62，79 years）presented with urinary frequency（10 - 90 min intervals），urgency，dysuria，lower abdominal pain，and non-organic sleep disorder，with nocturia（2 - 15 episodes）causing sleep difficulty. Disease durations were 3，6，and 21 years. Prior antibiotic therapy failed. Preoperative urinalysis/culture（x2）ruled out bacterial cystitis，and diagnosed as interstitial cystitis（IC），with one of transient positive urine culture. Preoperative scores for case 1 were self-rating depression scale（SDS）of 49，self-rating anxiety scale（SAS）of 31，interstitial cystitis symptom index（ICSI）of 5，interstitial cystitis problem index（ICPI）of 2，brief urological problem scale of 50，genitourinary pain assessment scale of 10，and pain catastrophizing scale（PCS）of 0. For case 2，the scores were 60 of SDS，66 of SAS，9 of ICSI，11 of ICPI，50 of brief urological problem scale，28 of genitourinary pain assessment scale，and 34 of PCS. For case 3，the scores were 44 of SDS，48 of SAS，11 of ICSI，5 of ICPI，33 of brief urological problem scale，27 of genitourinary pain assessment scale，and 21 of PCS. Preoperative bladder hydro-distention showed mucosal hemorrhage including central block hemorrhage（Case 1），numerous spots（Case 2），and distinct sheets（Case 3）. Preoperative urine 16S rRNA sequencing revealed low diversity，increased Gardnerella/ Bacteroides（opportunistic），and decreased Bacillus/ Streptococcus（beneficial）. Two healthy young female donors had normal comprehensive tests covering blood/urine/stool，coagulation，CRP，immunity，liver/kidney function，lipids，infectious diseases，hormones，tumor markers，urine culture，TOUCH，and expanded quantitative urine culture. Donor urine 16S rRNA showed low pathogenic（ Gardnerella/ Bacteroides）abundance. Donor midstream morning urine was catheter-collected，centrifuged，and the bacterial pellet resuspended in saline. Recipients underwent bladder irrigation pre-UMT. On UMT day，donor bacterial suspension was instilled via catheter with adverse event monitoring. Follow-up included clinic visits at 1 month and 1 year for symptom assessment，scale scoring，cystoscopy evaluating mucosal inflammation，hydrodistension checks，and telephone tracking of urinary symptoms every 2 - 3 months. Prognosis was assessed by symptom relief，scale score reduction，and mucosal recovery. Results:No adverse reactions occurred within 24 hours post-UMT in all 3 cases. Two patients showed same-day urinary urgency reduction；three reported relief from urinary frequency/urgency on postoperative day 7，with 2 - 3 hour daytime intervals and 0 - 5 nocturnal voids. Two patients experienced lower abdominal pain alleviation. Postoperative Week 1 urinalysis and urine cultures revealed no abnormalities. The 16S rRNA test showed a decrease in the abundance of harmful bacteria（e.g.， Cupriavidus，Ureaplasm，Mycobacterium，Pseudomonas）and an increase in the abundance of beneficial bacteria（ Dietzia，Halomonas，and Streptococcus），and the overall urobacterial structure was significantly improved and similar to that of the donor. Case 1 was followed up for 20 months，and the lab tests were normal，with SDS scales of 38，SAS of 20，ICSI of 3，ICPI of 2，brief urological problem scale of 44，genitourinary pain assessment scale of 10，PCS of 0，at 9 months post-op follow-up，indicating physical and mental improvement. The bladder hydro-distention revealed intact mucosa with only mild inflammation，which improved versus preoperative situation. Case 2 was followed up for 15 months，and the lab tests were normal，with SDS scales of 44，SAS of 34，ICSI of 4，ICPI of 2，brief scale of urinary problems of 0，genitourinary pain assessment scale of 9，PCS of 7，at 2 months post-op follow-up，showing improved anxiety/depression and quality of life. The hydro-distention showed decreased scattered hemorrhagic dots and mucosal inflammation. Case 3 was followed up for 13 months，with an increased leukocytes of urine and the other being normal for lab tests，and SDS scales of 35，SAS of 46，ICSI of 13，ICPI of 13，brief scale of urinary problems of 10，genitourinary pain assessment scale of 33，PCS of 11，at 13 months post-op follow-up，indicating physical and mental improvement. The hydro-distention revealed mucosal congestion，marked submucosal vasodilation，and inflammation decreased compared with preoperative situation. Conclusions:UMT alleviates urinary frequency，urgency，and pain in IC patients with sustained effects，significantly improves urine microecology，and shows no adverse events，positioning it as a viable intervention for IC.

Objective To evaluate the impact of integrated medical and nursing care teaching ward rounds on the theo-retical knowledge learning and clinical operational skill training of primary-level medical staff.Methods A total of 90 clinical healthcare workers(39 physicians and 51 nurses)from our hospital between May and December2024 were randomly assigned to either a control group or an intervention group.The control group participated in traditional three-tier nursing teaching ward rounds,while the intervention group underwent integrated medical and nursing care teaching ward rounds.The two groups were compared in terms of improvements in theoretical knowledge,ward round operational skills,and core clinical competencies.Re-sults Both groups demonstrated improvements in theoretical knowledge and ward round operational skills after the intervention,with the intervention group showing significantly greater gains(P＜0.05).Additionally,scores related to physical fitness,emo-tional well-being,and cognitive function improved in both groups,with significantly higher improvements in the intervention group(P＜0.05).The Clinical Nursing Skills(CINS)scores—including judgment,early warning,anticipatory thinking,and overall clinical competence—also improved significantly in the intervention group compared to the control group(P＜0.05).Conclu-sion Integrated medical and nursing care teaching ward rounds significantly enhance theoretical knowledge,operational profi-ciency,and core clinical competencies among primary healthcare providers.This model fosters higher professional engagement and helps cultivate qualified primary-level medical personnel who are better equipped to meet real-world clinical demands.

Objective To investigate the correlation of SII with occurrence of short-term MI in eld-erly patients with CHD complicated with T2DM.Methods A total of 382 CHD patients with con-comitant T2DM admitted in our hospital from January 2022 to January 2023 were enrolled,and according to occurrence of MI within 1 year,they were divided into a MI group(83 patients)and a non-MI group(299 patients).Clinical data were collected,and multivariate logistic regression analysis was used to determine the risk factors for MI in the patients.ROC curve was plotted to evaluate the predictive value of SII,fasting blood glucose(FPG)and their combination for 1-year MI occurrence.Kaplan-Meier curve was drawn to analyze the relationship between SII and MI.Results Multivariate logistic regression analysis showed that SII,FPG and peripheral atheroscle-rosis were risk factors for MI occurrence(OR=1.001,95％CI:1.000-1.001,P=0.001;OR=1.106,95％CI:1.016-1.203,P=0.020;OR=4.798,95％CI:2.621-8.786,P=0.000),and GLP-1RA and SGLT2i were protective factors for the occurrence(OR=0.255,95％CI:0.073-0.895,P=0.033;OR=0.474,95％CI:0.270-0.834,P=0.010).ROC curve analysis indicated showed that the AUC value of SII,FPG and their combination was 0.675,0.619 and 0.702,respectively,and the predictive performance was better in the combination than the indicator alone(P＜0.01).Kaplan-Meier curve analysis revealed that the cumulative survival rate in the high-level group was significantly lower than that in the low-level group(Plog rank＜0.01).Conclusion For the elderly T2DM patients with concomitant CHD,SII,FPG and atherosclerosis are independ-ent risk factors for MI occurrence.SII and FPG have certain predictive value for the occurrence.

Objective To investigate the correlation of SII with occurrence of short-term MI in eld-erly patients with CHD complicated with T2DM.Methods A total of 382 CHD patients with con-comitant T2DM admitted in our hospital from January 2022 to January 2023 were enrolled,and according to occurrence of MI within 1 year,they were divided into a MI group(83 patients)and a non-MI group(299 patients).Clinical data were collected,and multivariate logistic regression analysis was used to determine the risk factors for MI in the patients.ROC curve was plotted to evaluate the predictive value of SII,fasting blood glucose(FPG)and their combination for 1-year MI occurrence.Kaplan-Meier curve was drawn to analyze the relationship between SII and MI.Results Multivariate logistic regression analysis showed that SII,FPG and peripheral atheroscle-rosis were risk factors for MI occurrence(OR=1.001,95％CI:1.000-1.001,P=0.001;OR=1.106,95％CI:1.016-1.203,P=0.020;OR=4.798,95％CI:2.621-8.786,P=0.000),and GLP-1RA and SGLT2i were protective factors for the occurrence(OR=0.255,95％CI:0.073-0.895,P=0.033;OR=0.474,95％CI:0.270-0.834,P=0.010).ROC curve analysis indicated showed that the AUC value of SII,FPG and their combination was 0.675,0.619 and 0.702,respectively,and the predictive performance was better in the combination than the indicator alone(P＜0.01).Kaplan-Meier curve analysis revealed that the cumulative survival rate in the high-level group was significantly lower than that in the low-level group(Plog rank＜0.01).Conclusion For the elderly T2DM patients with concomitant CHD,SII,FPG and atherosclerosis are independ-ent risk factors for MI occurrence.SII and FPG have certain predictive value for the occurrence.