Objective:To construct the training course content for gastrointestinal endoscopy nurses based on job competency model.Methods:Based on the job competency model, the training course content for gastrointestinal endoscopy nurses was constructed on the basis of systematic literature search and semi-structured interviews combined with the Delphi expert consultation.Results:A total of 21 experts from nine regions including Beijing City, Hebei Province, Inner Mongolia Autonomous Region, Shanxi Province, Hubei Province, Tianjin City, Guangdong Province, Jilin Province, and Zhejiang Province were selected for consultation. There were two rounds of expert consultation. In the first round of expert consultation, 21 questionnaires were issued and 21 valid questionnaires were recovered, with an effective recovery rate of 100.00%, of which nine experts proposed a total of 38 amendments. In the second round of expert consultation, 21 questionnaires were issued and 17 valid questionnaires were recovered, with an effective recovery rate of 80.95%, of which two experts proposed modifications. For the two rounds of consultation, the expert authority coefficients were 0.871 and 0.882 respectively, and the coefficients of variation for each entry were 0 to 0.16 and 0 to 0.20, and the Kendall's harmony coefficients were 0.272 and 0.217 ( P<0.01). The finalized training course content for gastrointestinal endoscopy nurse based on job competency model consisted of four first-level indicators, 19 second-level indicators, and 53 third-level indicators. Conclusions:The training course content for the gastrointestinal endoscopy nurses constructed based on the job competency model is scientific, generalizable, and practical, and can provide reference and guidance for the training of endoscopic specialty nursing personnel.

Objective:To construct the training course content for gastrointestinal endoscopy nurses based on job competency model.Methods:Based on the job competency model, the training course content for gastrointestinal endoscopy nurses was constructed on the basis of systematic literature search and semi-structured interviews combined with the Delphi expert consultation.Results:A total of 21 experts from nine regions including Beijing City, Hebei Province, Inner Mongolia Autonomous Region, Shanxi Province, Hubei Province, Tianjin City, Guangdong Province, Jilin Province, and Zhejiang Province were selected for consultation. There were two rounds of expert consultation. In the first round of expert consultation, 21 questionnaires were issued and 21 valid questionnaires were recovered, with an effective recovery rate of 100.00%, of which nine experts proposed a total of 38 amendments. In the second round of expert consultation, 21 questionnaires were issued and 17 valid questionnaires were recovered, with an effective recovery rate of 80.95%, of which two experts proposed modifications. For the two rounds of consultation, the expert authority coefficients were 0.871 and 0.882 respectively, and the coefficients of variation for each entry were 0 to 0.16 and 0 to 0.20, and the Kendall's harmony coefficients were 0.272 and 0.217 ( P<0.01). The finalized training course content for gastrointestinal endoscopy nurse based on job competency model consisted of four first-level indicators, 19 second-level indicators, and 53 third-level indicators. Conclusions:The training course content for the gastrointestinal endoscopy nurses constructed based on the job competency model is scientific, generalizable, and practical, and can provide reference and guidance for the training of endoscopic specialty nursing personnel.

Neutrophils are the most abundant circulating white blood cells and play an indispensable role as first responders of damaged tissue and infected sites in the early inflammatory response of healing. Neutrophils provide immediate host defense by engulfing and destroying pathogens, releasing cytotoxic enzymes and metabolites, and spreading inflammatory networks. However, if left uncontrolled, these defense mechanisms can cause significant collateral damage. Focusing on the triggers of harmful neutrophil inflammation and immunomodulatory deficits, as well as grasping the specific drivers of harmful inflammation, is of great significance for recalibrating inflammation to promote endogenous tissue repair. This article, starting from the causes of neutrophil inflammation imbalance, elaborated the main mechanism of neutrophil-mediated tissue injury and related pathological manifestations, and highlighted the therapeutic targets with promising applications.

Objective:To investigate the clinical effect of a 3D reconstruction assisted preoperative optimal design of anterolateral abdomen cross-region free perforator flaps for repair of soft tissue defects of limbs.Methods:Twenty patients who were treated for soft tissue defects of hand, forearm, foot and ankle in the Department of Hand Surgery, the Sixth Hospital of Ningbo from October 2017 to January 2020 were included in this study. Among the patients,17 had soft tissue defects in hand and forearm and 3 with composite tissue defects including ankle and soft tissue defect of foot. The sizes of soft tissue defects in limbs ranged from 6 cm × 8 cm - 36 cm × 18 cm. Twenty free cross-area perforator flaps were optimal designed with CTA and 3D assisted reconstruction before surgery. Following combinations of flaps were designed: (1) Free perforator flap with inferior abdominal artery and superior abdominal artery; (2) Free perforator flap with superficial iliac circumflex artery and deep iliac circumflex artery; (3) Free perforator flap with superficial iliac circumflex artery and inferior abdominal wall perforator artery; (4) Free perforator flap with perforators of superficial iliac circumflex artery plus superficial abdominal artery; (5) Free perforator flap with perforating artery of lower abdominal wall and superficial artery of abdominal wall. The overall nutritional area of a combined flap were 272.3 cm 2± 12.5 cm 2, 107.4 cm 2± 9.3 cm 2, 193.6 cm 2± 24.2 cm 2, 155.2 cm 2± 20.1 cm 2 and 203.7 cm 2± 16.3 cm 2, respectively. All the donor sites were sutured directly in one stage. The appearance, texture, blood supply, colour, joint movement of affected limbs, recovery and function of donor sites were observed through postoperative follow-up visits at the outpatient clinic. Results:Among the 20 anterolateral transventral perforator flaps, 18 flaps survived successfully; One had partial necrosis after surgery, and healed after dressing change. Subcutaneous haematoma occurred in 1 flap, and survived after drainage. In this study, there was no postoperative infection of flap. A total of 19 flaps healed in one stage, except 1 that had a delayed healing and the flap wound was closed after dressing change for 1 week. According to Disability of Arm, Shouder and Hand (DASH) questionnaire evaluation, which is widely used in the world to evaluate the therapeutic effect after limb injury, combined with the 6-12 months of follow-up, the functional recovery of 17 patients with upper limbs iniury was 7 in excellent, 9 in good and 1 in poor. The overall excellent and good rate achieved 94.1%. All the 3 patients with foot injury recovered well, and the walking and jumping were not significantly affected. The results were all excellent according to the Maryland Foot Function Scoring. Sensation of flaps was evaluated according to the British Sensory Function Evaluation, it showed: 3 in S 2, 15 in S 3 and 2 in S 3+. All 20 flaps had good blood supply, in soft texture, good colour, feeling, thickness and movement. The donor sites all healed well. Conclusion:Combined with an optimal preoperative design, the perforator flap of anterior lateral wall cross-region can obtain a satisfactory clinical efficacy in repair of large area soft tissue defects. It is a feasible treatment method.

Objective:To investigate the feasibility and safety of a novel single-port robotic surgical system with flexible 3D endoscope and deformable surgical instruments in zero ischemic partial nephrectomy.Methods:From May 2021 to October 2021, a prospective study on patients with renal tumor who plan to receive zero ischemic partial nephrectomy was conducted. Inclusion criteria included over 18 years old, body index between 18.5 to 30.0 kg/m2, American Society of Anesthesiologists Score ranged from 1 to 3 points, cooperation with the follow-up and related examinations, voluntary in participating the clinical trial and signing the informed consent. Exclusion criteria included patients with other co-existed malignant tumors or a medical history of other malignant tumors, the patients who have received the same urological surgery in the past, the patients who underwent or plan to undergo other major operations 3 months before or after the surgery, the patients with active pulmonary tuberculosis or severe systemic diseases, the patients to be considered not suitable to enroll in by the researchers. A novel single-port robotic surgical system was used to perform the surgery. The system consiststed of a remote control console, a surgical equipment cart, a four-arm operation cart and deformable robotic instruments which were reusable. The two-section deformable robotic instruments were able to bend in four directions and carried different surgical instruments such as unipolar scissors, bipolar grasping forceps and needle holders. The deformable robotic instruments entered the body through a special trocar with single hole and multi-channel, and then unfolded in a triangle. By bending instruments, surgeons could perform single-port robotic surgery without the trouble of "chopstick effect" or "reverse direction" . Four cases of single-port partial nephrectomy were carried out. Under general anesthesia, the patients were taken the lateral recumbent position, with elevated waist and lowered head and feet. A 3-4 cm incision was taken layer by layer along the lateral edge of the rectus abdominis at the umbilicus level. A special 2.5 cm robotic trocar was set into the cavity, and a high-definition 3D laparoscopic lens and a snake shaped mechanical arm were then put into the abdominal cavity through the trocar. All operations were performed by transperitoneal approach with an auxiliary port through the same or a different skin incision if necessary. Tumor resection and renal reconstruction were performed by the way of zero ischemia. The perioperative parameters such as tumor size, operation time, intraoperative bleeding and postoperative complications were analyzed.Results:Four patients were involved, including 2 males and 2 females, with 2 of them having a history of hypertension. The ECOG scores were all 0, and KPS score was 100 in 3 cases and 90 in 1 case. Preoperative mean serum creatinine was (76.8±18.8)μmol/L (range 70-104 μmol/L). The tumors were located on the left in 3 cases and on the right in 1 case. The diameter of the tumor ranged from 1.1 to 2.8 cm, with the TNM classification of T 1a. The R. E.N.A.L. scores were 4a, 7p, 6p and 4P respectively. The first operation was performed by pure single-port surgery, and the other 3 cases were performed with the help of an auxiliary port to ensure the safety .The operation time ranged from 155 min to 210 min, and the intraoperative bleeding ranged from 20 ml to 170 ml. Postoperative pathology showed 2 cases of renal clear cell carcinoma with negative margin and 2 cases of angiomyolipoma. No severe complications, such as bleeding or urinary leakage, were observed during the perioperative period, and the change of serum creatinine was insignificant before discharge and before operation( P=0.24). Conclusions:A robotic single-port partial nephrectomy can be successfully carried out by using this novel single-port robotic surgical system with flexible 3D endoscope and deformable surgical instruments.

The Essex-Lopresti lesion is characterized by a fracture of the radial head with concomitant rupture of the interosseous membrane and disruption of the distal radioulnar joint. The EssexLopresti lesion is rare and serious, easily subject to missed diagnosis. However, all sorts of therapeutic methods can only yield poor results for chronic Essex-Lopresti lesion. Therefore, early and accurate diagnosis is crucial. The key to treat acute Essex-Lopresti lesion is the reconstruction of radial head and restoration of radius length, preventing the proximal move of radius. At the same time, the distal radioulnar joint should be reset and stablized, and the triangular fibrocartilage complex(TFCC) repaired, so as to restore the normal anatomic relation between radiu and ulna and to reconstruct forearm longitudinal stability. Further studies are needed on whether the forearm interosseous membrane needs repair as well as on repair method selection. The author reviews the Essex-Lopresti injury treatment methods in order to facilitate better clinical treatment.

Radial head fracture accounts for one third of the elbow joint fracture.At present,for fractures without obvious displacement,non operative treatment can achieve good results.In the case of complicated comminuted fracture of the radial head,open reduction with internal fixation and the radial head replacement have their own advantages and disadvantages.There is no exact reference for the selection of surgical procedures,and the best treatment regimen remains controversial.No matter which method is adopted,it is necessary to repair accompanied injuries.Meanwhile,postoperative standard rehabilitation exercise is also essential for the recovery of elbow function.The typing of radial head comminuted fracture and the status quo of its treatment is reviewed in this paper,so as to provide reference for better clinical treatment.

Objective Toinvestigatetheexpressionofsuppressorofcytokinesignaling1(SOCS1)inoverloaded ventricle papillary muscle, so as to understand its expression characteristics in structural remodeling after the overloading and the biomechanical properties of the muscle under cubic jellyfish toxin-1(CfTX-1) pretreatment that can affect cell signal transduction. Methods Abdominal aortic-venous fistula (AVF) were operated in Kunming mice (n=5), and the cardiac left ventricles were harvested after two weeks of fistulation. The mice in normal group were sham operated as a control (n=5). In vitro culture, the left ventricular papillary muscle of normal mice was used (n=20). In the stretching group, the isolated papillary muscles were double-ratio stretched and fixed on silicone plate. In the relaxation group, the muscles were not stretched. A separated subgroup that transfected with SOCS1 plasmids were set in each group of stretching and relaxation. The papillary muscle samples of each group were cultured in culture medium for 3 days at 37 ℃, and then homogenized for extracting total protein. The total protein was separated by 10％ sodium dodecyl sulfate-polyacrylamide gel electrophoresis. The 23 ku band with SOCS1 was used as the target band, and the integrated optical density (IOD) value was measured by computer image analysis method. The expression of SOCS1 protein was detected by Western Blot and the imprinted IOD value was also measured. The papillary muscle in the stretching group was stretched by micro-positioned stretching method, and the initial load was 1 g. After stabilization, the papillary muscle was stretched by 15 mm for continuously 5 times, and the passive tension characteristic curves during the first and fifth stretching were observed and recorded. The peak passive tension (PTmax) and its deceleration velocity (DV) of the papillary muscle were calculated based on the curves. Results Comparing with the AVF group, the normal group had higher IOD values of 23 ku band and SOCS1 blot in total protein of the papillary muscle, and the differences were statistically significant (all P<0.01). The IOD value of 23 ku band in the SOCS1 transfected stretching group was significantly higher than those of the two relaxation groups, and the differences were statistically significant (all P<0.01). However, the difference of this value was not statistically significant between the two relaxation groups. The average IOD value of SOCS1 blot in the SOCS1 transfected stretching group was higher than those of the normal stretching group and the SOCS1 transfected relaxation group, and the differences were statistically significant (all P<0.01). Comparing with the normal group, the AVF group had higher PTmax and ultimate PTmax of the papillary muscles, and had a lower DV values, and the differences were statistically significant (all P<0.01). Conclusions The expression of SOCS1 is sensitive to tension load, and has a positive effect as an overload-sensitive signal in improving myocardial adaptability, protecting myocardial structure and maintaining systolic and diastolic function. CfTX-1 also has a positive effect on improving the compliance of ventricular papillary muscles.

Objective To establish a pre-audit system for medical orders in hospitalized patients and increase the auditing rate in inpatients. Methods In the pre-audit system for medical orders, browser/server(B/S)and client/server(C/S)hybrid architecture was adopted and JAVA language was used for programming. The pre-audit system for medical orders was linked to the hospital information system and data integration platform,and audit module was improved on the basis of the pre-audit system for prescriptions which had been successfully operated in Xuanwu Hospital of Capital Medical University. More than 20 thousand related rules were added in the audit think tank for rational drug use of prescriptions and serious errors interception for indications,dosage and administration route,appropriate translation of Chinese patent medicine indications,refinement of compatibility taboos,audit of drug allergy risk,appropriate audit for pain medications,and audit for rational drug use related to height,body weight,body surface area,and test values were performed. The audit think tank for rational drug use was formed,which set up the foundation for intelligent examination of medical orders. The medical orders which were not passed by intelligent examination were transmitted to the pre-audit pharmacist to audit for the second time. By comparing the audit rate of medical orders in hospitalized patients before and after adopting the pre-audit system and the qualification rate at the first 4 months after adopting the system,the application effect was preliminarily evaluated. Results After launching pre-audit system for medical orders in June 2017,the examination rate of medical orders in inpatients increased from 42.53%(61 139/143 756)to 100%(at the first 4 months,the number of doctor′s orders was 69 183,74 072,99 816,and 184 184,respectively). At the first 4 months after the system was launched,the pass rate of audit for medication orders was 69.02%(47 753/69 183),84.27%(62 416/74 072),92.69%(92 516/99 816),and 97.21%(179 040/184 184),respectively. The difference in passing rate of audit for medication orders between the 4th month and the first month was statistically significant(χ2=42 548.86,P<0.001). Conclusions The pre-audit system for inpatients′medication orders was successfully established. The intelligent audit for all inpatients realized using this pre-audit system and was of benefit to the rational drug use improvement in hospitals.

Objective To establish a pre-audit system for medical orders in hospitalized patients and increase the auditing rate in inpatients. Methods In the pre-audit system for medical orders, browser/server(B/S)and client/server(C/S)hybrid architecture was adopted and JAVA language was used for programming. The pre-audit system for medical orders was linked to the hospital information system and data integration platform,and audit module was improved on the basis of the pre-audit system for prescriptions which had been successfully operated in Xuanwu Hospital of Capital Medical University. More than 20 thousand related rules were added in the audit think tank for rational drug use of prescriptions and serious errors interception for indications,dosage and administration route,appropriate translation of Chinese patent medicine indications,refinement of compatibility taboos,audit of drug allergy risk,appropriate audit for pain medications,and audit for rational drug use related to height,body weight,body surface area,and test values were performed. The audit think tank for rational drug use was formed,which set up the foundation for intelligent examination of medical orders. The medical orders which were not passed by intelligent examination were transmitted to the pre-audit pharmacist to audit for the second time. By comparing the audit rate of medical orders in hospitalized patients before and after adopting the pre-audit system and the qualification rate at the first 4 months after adopting the system,the application effect was preliminarily evaluated. Results After launching pre-audit system for medical orders in June 2017,the examination rate of medical orders in inpatients increased from 42.53%(61 139/143 756)to 100%(at the first 4 months,the number of doctor′s orders was 69 183,74 072,99 816,and 184 184,respectively). At the first 4 months after the system was launched,the pass rate of audit for medication orders was 69.02%(47 753/69 183),84.27%(62 416/74 072),92.69%(92 516/99 816),and 97.21%(179 040/184 184),respectively. The difference in passing rate of audit for medication orders between the 4th month and the first month was statistically significant(χ2=42 548.86,P<0.001). Conclusions The pre-audit system for inpatients′medication orders was successfully established. The intelligent audit for all inpatients realized using this pre-audit system and was of benefit to the rational drug use improvement in hospitals.