A 28-year-old woman presented with a 4-year history of fatigue and sleepiness and was found to have central hypothyroidism and mood disorder. The patient had normal thyroid volume and did not show any other pituitary axis involvement. Over the course of the disease, her symptom improvement matched with the free thyroxine (FT 4) rebound and the adjustment of antipsychotic medication. The patient′s grandmother had central hypothyroidism, and her mother and uncle had lowered or inappropriately normal thyroid stimulating hormone. Hence, genetic involvement was highly suspected, but whole exon sequencing did not reveal a pathogenic variant. Levothyroxine tablets were prescribed to maintain a normal median level of FT 4, and mood disorder medications were adjusted by specialists. Isolated central hypothyroidism is extremely rare, and we report this case aiming to raise awareness of this condition.

Objective:To search and evaluate the relevant evidence of percutaneous external fixation needle care management, and integrate the evidence to provide the best nursing management strategy for clinical needle care.Methods:BMJ best clinical practice, UpToDate, PubMed, CINAHL, ProQuest, CNKI, Wanfang database and other domestic and foreign databases related to clinical practice guidelines, evidence summary, expert consensus, systematic evaluation, randomized controlled trial were searched. The search period was from database inception to November 2023. Evaluated the quality of the included literatures, and conduct evidence extraction, level evaluation and evidence summary analysis.Results:A total of 11 articles were included, including 1 guideline, 1 evidence summary, 3 systematic reviews, 2 expert consensus, and 4 randomized controlled trials. The 10 pieces of best evidence were summarized in 5 categories, including needle evaluation, cleaning management, scab management, disinfection management, and dressing management.Conclusions:This study summarized the best evidence on the management of percutaneous external fixation needle care, and provides evidence- based basis for clinical nurses to perform needle care. In clinical practice, evidence should be selectively and reasonably applied in combination with clinical situations and relevant factors to promote the improvement and development of clinical nursing work.

Objective:To analyze the expression and clinical significance of SHC SH2-binding protein 1(SHCBP1)in lung adenocarcinoma(LUAD).Methods:Oncomine,TIMER,UALCAN,GEPIA,Kaplan-Meier plotter and STRING databases were used to explore the effect of SHCBP1 on progression and immune infiltration of LUAD.Results:Expression of SHCBP1 mRNA in LUAD tissue was significantly higher than that in normal lung tissue(P<0.05).Expression of SHCBP1 mRNA was significantly increased in LUAD patients with smoking history,nodal metastasis,late clinical stage and TP53 mutation(P<0.05).Survival analysis by GEPIA and Kaplan-Meier plotter databases showed that LUAD patients with high SHCBP1 mRNA expression had a lower overall survival rate(P<0.05).SHCBP1 mRNA was correlated with immune cell infiltration,immune cell markers and immune checkpoint expression in LUAD.Conclusion:High expression of SHCBP1 is related to poor prognosis and tumor immune infiltration of LUAD patients.

Objective:To investigate the current status of emotional intelligence of standardized training nurses and explore the influencing factors.Methods:A total of 312 standardized training nurses from the Fifth Affiliated Hospital of Sun Yat-sen University and the First Affiliated Hospital of Nanchang University were investigated from May to June 2020 with general information questionnaire and Nurses′ Emotional Intelligence Scale, and analyze the influencing factors of nurses′ emotional intelligence during the standar dized training period.Results:The total score of standardized training nurses′ emotional intelligence was (59.01 ± 8.24), the scoring rate was 73.76%, and the total average score of items was (3.69 ± 0.52). The average scores of the four dimensions from low to high were: self emotion assessment (3.86 ± 0.66), self emotion management (3.67 ± 0.71), self emotion application (3.64 ± 0.67) and emotion assessment of others (3.58 ± 0.65). Multiple linear regression analysis showed that political outlook, whether it was an only child, and training time and willingness to engage in nursing work for a long time were the main influencing factors of standardized training nurses′ emotional intelligence, accounting for 32.6% of the variance.Conclusions:The emotional intelligence of standardized training nurses is at the medium level, which needs to be further improved. Hospital managers need to carry out positive intervention combined with relevant influencing factors to cultivate more excellent nursing talents for clinical practice.

Objective:To explore the mediating role of occupational benefit in the emotional intelligence and emotional labor of nurses during the standardized training period, so as to provide references for enhancing the professional adaptation potential of nurses during the standardized training period.Methods:This study was a cross-sectional study. Using the convenient sampling method, a total of 318 standardized training nurses from the Fifth Affiliated Hospital of Sun Yat-sen University and the First Affiliated Hospital of Nanchang University were selected as research objects from May to June 2020. They were investigated by general data questionnaire, Emotional Intelligence Scale, Occupational Benefit Scale and Emotional Labor Scale. Structural equation model (SEM) was used to explore the mediating effect of occupational benefit on emotional intelligence and emotional labor.Results:A total of 318 questionnaires were collected in this study, among which 312 were valid. The mean scores of items of emotional intelligence and occupational benefits of 312 nurses were (3.69±0.52) and (3.97±0.54) , respectively. The average scores of the three dimensions of emotional labor were surface acting (3.42±0.95) , emotional expression requirements (3.62±0.99) and deep acting (4.62±0.86) . There were correlations between emotional intelligence, occupational benefit and emotional labor (all P<0.05) . The structural equation model showed that the emotional intelligence and occupational benefit of nurses in the standardized training period had direct predictive effects on emotional labor, and emotional intelligence also indirectly affected emotional labor with occupational benefit as an intermediary variable. The structural equation fitting index χ 2/ df was 1.731, the goodness of fit index was 0.949, the adjusted goodness of fit index was 0.912 and the root mean square error of approximation was 0.058. Conclusions:Occupational benefit has a partial mediating effect between the emotional intelligence and emotional labor of nurses during the standardized training period. Nursing managers can take effective measures to improve the emotional intelligence level of nurses during the standardized training period, enhance the sense of occupational benefit and optimize their emotional labor performance from individual factors.

Objective:To investigate the current status of emotional labor of nurses in standardized training period, and to analyze the relationship between emotional labor and emotional intelligence.Methods:From May to June 2020, 312 nurses in the standardized training period were selected as the research objects, which were investigated with general information questionnaire, Emotional Labor Scale and Emotional Intelligence Scale.Results:The total score of standardized training nurses' emotional labor was (52.27±10.18) points, and the total average score of items was (3.73±0.73) points. The average scores of the three dimensions from high to low: deep acting (4.62±0.86) points, expression of genuine emotion (3.62±0.99) points and surface acting (3.42±0.95) points. There was a correlation between emotional intelligence and emotional labor. Multiple linear regression analysis showed that the emotional evaluation of others ( β value was -0.189, P<0.05) ( β value was -0.255, P<0.01). Self emotional assessment ( β value was 0.297, P<0.01) ( β value was 0.177, P<0.05). Self emotional assessment ( β value was 0.269, P<0.05), which had a positive predictive effect on emotional expression requirements. Conclusions:The emotional labor of nurses in standardized training period is at the medium level, and the deep acting score is the highest between three dimensions. Hospital managers could promote nurses to use appropriate emotional labor strategies by strengthening the cultivation of emotional intelligence during standardized training period.

Objective:To summarize the clinical features of patients with inflammatory bowel disease (IBD) .Methods:Clinical data of patients diagnosed as IBD in the First Affiliated Hospital, Zhejiang University of Traditional Chinese Medicine from July 2013 to July 2018 were retrospectively analyzed.Results:Of 335 IBD patients, 151 were diagnosed as ulcerative colitis (UC) and 184 were Crohn′s disease (CD) . The average age of UC was higher than that of CD [ (45.50 ± 15.40) years vs. (36.15 ± 13.48) years, P<0.001]. Diarrhea, mucopurulence and bloody stool were more common in UC patients (all P<0.001) , while abdominal pain, anal fistula and perianal abscess were significantly increased in CD patients (all P<0.001) . Conclusions:The age of CD was earlier than that of UC. Diarrhea, mucopurulent and bloody stool were more common in UC, and abdominal pain, anal fistula and perianal abscess were more common in CD. Patients suspected of CD should be routinely examined by endoscopy, especially gastroscopy, to prevent missed diagnosis.

Objective:To summarize the clinical features of patients with inflammatory bowel disease (IBD) .Methods:Clinical data of patients diagnosed as IBD in the First Affiliated Hospital, Zhejiang University of Traditional Chinese Medicine from July 2013 to July 2018 were retrospectively analyzed.Results:Of 335 IBD patients, 151 were diagnosed as ulcerative colitis (UC) and 184 were Crohn′s disease (CD) . The average age of UC was higher than that of CD [ (45.50 ± 15.40) years vs. (36.15 ± 13.48) years, P<0.001]. Diarrhea, mucopurulence and bloody stool were more common in UC patients (all P<0.001) , while abdominal pain, anal fistula and perianal abscess were significantly increased in CD patients (all P<0.001) . Conclusions:The age of CD was earlier than that of UC. Diarrhea, mucopurulent and bloody stool were more common in UC, and abdominal pain, anal fistula and perianal abscess were more common in CD. Patients suspected of CD should be routinely examined by endoscopy, especially gastroscopy, to prevent missed diagnosis.

Objective By analyzing the problems existed in the Investigator Initiated Trial (IIT),this article put forward the corresponding countermeasures and therefore provides reference for the standardization of clinical research project management.Methods Four types of problems identified in the supervision of hospital IIT projects are analyzed according to literature review,data analysis of clinical research project,comparative study and summary.Identified problems are existed in the following aspects:scientific research supervision function,research method guidelines,technical specification of the diagnosis and treatment,scientific research design and project approval review,research funds,medical ethics committee,construction of Biobank and Regulation Conflicts.Results This article put forward 6 countermeasures for improvement:establishing and perfect IIT project scientific research supervision entity,bring in the IIT project steering group to strengthen the scientific review;Strengthen risk management to ensure medical safety,carry out IIT training,establish IIT management database information system,build a comprehensive integrated development multi-point application model of hospital BioBank.Conclusions The establishment of the hospital's IIT scientific research supervision system,management mode and technical standard system is of great importance to standardize clinical research,ensure research quality and guide the clinical research work of the hospital effectively.