Objective: To develop a convenient, direct, and highly sensitive method for screening trace chemical additives in complex Chinese patent medicines, thereby addressing core technological bottlenecks in pharmaceutical analysis and quality control. Methods: A brush ionization probe device was independently designed and constructed, and an efficient detection method was established through systematic optimization of key parameters. Twenty-three Chinese patent medicine samples, representing 6 dosage forms (capsules, tablets, pills, granules, powders, and liquid preparations), were analyzed using 10 common chemical additives as target analytes. Results: All samples were successfully analyzed without complex pretreatment, and 5 chemical additives were detected in 7 Chinese patent medicines. The brush ionization probe device exhibited cost-effectiveness (~0.2 USD per probe), operational simplicity, rapid analysis (~10s per sample), high efficiency, and minimal reagent consumption (~10 μL per sample). Conclusion: This advancement is expected to provide an innovative scientific tool for improving the generality and convenience of on-site quality control, while promoting technological progress in disciplines such as pharmacology and traditional Chinese medicine.

Objective To evaluate the effectiveness of a preventive workflow in participatory observation based on healthcare failure mode and effect analysis(HFMEA)in reducing intraoperative acquired pressure injury(IAPI)in patients undergoing spinal surgery,and to provide evidences for prospective nursing management.Methods A preventive workflow of participatory observation-based HFMEA was established,which included defining HFMEA topic,forming a multidisciplinary team,creating a process map(through participatory observation),conducting failure mode and hazard analysis(using a Hazard scoring matrix and decision tree analysis,and identifying the causes of key failure through Pareto chart analysis),implementing improvement actions,and tracking effectiveness.Ultimately,11 high-risk failure modes were identified for further improvement:poor design of form/information system,heavy workload and fast pace,lack of departmental regulations,risk factors of IAPI,and unclear duty and responsibility in a multidisciplinary team.A series measures for improvement were developed and implemented based on the identified key causes.A pre-and post-control study was carried out.A total of 180 patients who received spinal surgery between November and April 2024 and received traditional preventive methods were assigned to a control group.While further 218 patients who received spinal surgery between May and December 2023 were assigned to the trial group with the participatory observation on the basis of HFMEA prevention workflow.IAPI incidence rate and severity were compared between the two groups,as well as the completion rate of preoperative IAPI risk assessment in the trial group.Results The trial group demonstrated significantly lower IAPI incidence and severity compared with those in the control group(P<0.05).In the trial group,178 patients(98.92%)completed the preoperative IAPI risk assessment,and 172 patients(95.47%)completed the intraoperative assessment.Conclusion The participatory observation based HFMEA prevention workflow can effectively reduce an incidence and severity of IAPI in patients undergoing spinal surgery,ensure patient safety and thereby enhance the quality of nursing management.

Objective To detect the serum soluble endothelial factor(sEng)and placental protein 13(PP13)levels on fetal growth restriction(FGR)in patients with early-onset severe preeclampsia(EOSP)and toanalyze the predictive value.Methods A total of 138 EOSP patients admitted to the obstetrics and gynecology department of Department of Obstetrics,Handan Central Hospital from February 2022 to December 2023 were included as the eclampsia group.Patients with FGR were classified as the restricted group(n=72),while those without FGR were classified as the unrestricted group(n=66).49 healthy pregnant women who underwent physical examination at Department of Obstetrics,Handan Central Hospital were regarded as control group.The general information of the eclampsia group was collected and statistically analyzed.ELISA method was applied to detect sEng and PP13 in serum.Pearson correlation was applied to analyze the correlation between serum sEng,PP13 and neonatal weight.Logistic regression model was applied to analyze the influencing factors of FGR in EOSP patients.ROC curve was applied to analyze the value of serum sEng and PP13 in predicting FGR in EOSP patients.Results The serum sEng(39.03±4.02 ng/L)of the eclampsia group was higher than that of the control group(32.75±3.64 ng/L),and PP13(1.20±0.20 μg/L)was lower than that of the control group(1.69±0.28 μg/L),and the differences were statistically significant(t=9.622,13.182,all P<0.05).The systolic blood pressure(172.64±7.52 mmHg),diastolic blood pressure(109.56±3.29 mmHg),24-hour urine protein(1 951.08±210.16 mg/24 h),adverse maternal and infant outcomes(33.33%)and sEng(41.56±4.22 ng/L)in the restricted group were higher than those in the unrestricted group(166.72±5.11 mmHg,106.39±4.88 mmHg,1504.36±164.27 mg/24 h,12.12%,36.28±3.81 ng/L),and neonatal weight(1 864.07±191.33 g),PP13(1.08±0.13 μg/L)was lower than that in the unrestricted group(2437.94±257.81g,1.34±0.27 μg/L),and the differences were statistically significant(t=4.507～14.930,all P<0.05).Serum sEng was negatively correlated with neonatal weight(r=-0.532,P<0.001),while serum PP13 was positively correlated with neonatal weight(r=0.471,P<0.001).High systolic blood pressure,high diastolic blood pressure,high 24-hour urine protein,and high sEng were risk factors for FGR in EOSP patients,while high PP13 was a protective factor(Wald χ2=4.731～129.166,all P<0.05).The AUC(95%CI)predicted by combined detection of serum sEng and PP13 was higher than AUC(95%CI)predicted by single detection and the differences were statistically significant(Z=2.790,3.443,all P<0.05).Conclusion EOSP patients with FGR have higher serum sEng level and lower PP13 level.sEng and PP13 are influencing factors for FGR in EOSP patients.Combined detection can improve the clinical value of predicting FGR in EOSP patients.

Objective To detect the serum soluble endothelial factor(sEng)and placental protein 13(PP13)levels on fetal growth restriction(FGR)in patients with early-onset severe preeclampsia(EOSP)and toanalyze the predictive value.Methods A total of 138 EOSP patients admitted to the obstetrics and gynecology department of Department of Obstetrics,Handan Central Hospital from February 2022 to December 2023 were included as the eclampsia group.Patients with FGR were classified as the restricted group(n=72),while those without FGR were classified as the unrestricted group(n=66).49 healthy pregnant women who underwent physical examination at Department of Obstetrics,Handan Central Hospital were regarded as control group.The general information of the eclampsia group was collected and statistically analyzed.ELISA method was applied to detect sEng and PP13 in serum.Pearson correlation was applied to analyze the correlation between serum sEng,PP13 and neonatal weight.Logistic regression model was applied to analyze the influencing factors of FGR in EOSP patients.ROC curve was applied to analyze the value of serum sEng and PP13 in predicting FGR in EOSP patients.Results The serum sEng(39.03±4.02 ng/L)of the eclampsia group was higher than that of the control group(32.75±3.64 ng/L),and PP13(1.20±0.20 μg/L)was lower than that of the control group(1.69±0.28 μg/L),and the differences were statistically significant(t=9.622,13.182,all P<0.05).The systolic blood pressure(172.64±7.52 mmHg),diastolic blood pressure(109.56±3.29 mmHg),24-hour urine protein(1 951.08±210.16 mg/24 h),adverse maternal and infant outcomes(33.33%)and sEng(41.56±4.22 ng/L)in the restricted group were higher than those in the unrestricted group(166.72±5.11 mmHg,106.39±4.88 mmHg,1504.36±164.27 mg/24 h,12.12%,36.28±3.81 ng/L),and neonatal weight(1 864.07±191.33 g),PP13(1.08±0.13 μg/L)was lower than that in the unrestricted group(2437.94±257.81g,1.34±0.27 μg/L),and the differences were statistically significant(t=4.507～14.930,all P<0.05).Serum sEng was negatively correlated with neonatal weight(r=-0.532,P<0.001),while serum PP13 was positively correlated with neonatal weight(r=0.471,P<0.001).High systolic blood pressure,high diastolic blood pressure,high 24-hour urine protein,and high sEng were risk factors for FGR in EOSP patients,while high PP13 was a protective factor(Wald χ2=4.731～129.166,all P<0.05).The AUC(95%CI)predicted by combined detection of serum sEng and PP13 was higher than AUC(95%CI)predicted by single detection and the differences were statistically significant(Z=2.790,3.443,all P<0.05).Conclusion EOSP patients with FGR have higher serum sEng level and lower PP13 level.sEng and PP13 are influencing factors for FGR in EOSP patients.Combined detection can improve the clinical value of predicting FGR in EOSP patients.

Objective To evaluate the effectiveness of a preventive workflow in participatory observation based on healthcare failure mode and effect analysis(HFMEA)in reducing intraoperative acquired pressure injury(IAPI)in patients undergoing spinal surgery,and to provide evidences for prospective nursing management.Methods A preventive workflow of participatory observation-based HFMEA was established,which included defining HFMEA topic,forming a multidisciplinary team,creating a process map(through participatory observation),conducting failure mode and hazard analysis(using a Hazard scoring matrix and decision tree analysis,and identifying the causes of key failure through Pareto chart analysis),implementing improvement actions,and tracking effectiveness.Ultimately,11 high-risk failure modes were identified for further improvement:poor design of form/information system,heavy workload and fast pace,lack of departmental regulations,risk factors of IAPI,and unclear duty and responsibility in a multidisciplinary team.A series measures for improvement were developed and implemented based on the identified key causes.A pre-and post-control study was carried out.A total of 180 patients who received spinal surgery between November and April 2024 and received traditional preventive methods were assigned to a control group.While further 218 patients who received spinal surgery between May and December 2023 were assigned to the trial group with the participatory observation on the basis of HFMEA prevention workflow.IAPI incidence rate and severity were compared between the two groups,as well as the completion rate of preoperative IAPI risk assessment in the trial group.Results The trial group demonstrated significantly lower IAPI incidence and severity compared with those in the control group(P<0.05).In the trial group,178 patients(98.92%)completed the preoperative IAPI risk assessment,and 172 patients(95.47%)completed the intraoperative assessment.Conclusion The participatory observation based HFMEA prevention workflow can effectively reduce an incidence and severity of IAPI in patients undergoing spinal surgery,ensure patient safety and thereby enhance the quality of nursing management.

Objective:Osteosarcoma is a highly aggressive primary malignant bone tumor commonly seen in children and adolescents,with a poor prognosis.Anchorage-dependent cell death(anoikis)has been proven to be indispensable in tumor metastasis,regulating the migration and adhesion of tumor cells at the primary site.However,as a type of programmed cell death,anoikis is rarely studied in osteosarcoma,especially in the tumor immune microenvironment.This study aims to clarify prognostic value of anoikis and tumor immune microenvironment-related gene in the treatment of osteosarcoma. Methods:Anoikis-related genes(ANRGs)were obtained from GeneCards.Clinical information and ANRGs expression profiles of osteosarcoma patients were sourced from the therapeutically applicable research to generate effective therapies and Gene Expression Omnibus(GEO)databases.ANRGs highly associated with tumor immune microenvironment were identified by the estimate package and the weighted gene coexpression network analysis(WGCNA)algorithm.Machine learning algorithms were performed to construct long-term survival predictive strategy,each sample was divided into high-risk and low-risk subgroups,which was further verified in the GEO cohort.Finally,based on single-cell RNA-seq from the GEO database,analysis was done on the function of signature genes in the osteosarcoma tumor microenvironment. Results:A total of 51 hub ANRGs closely associated with the tumor microenvironment were identified,from which 3 genes(MERTK,BNIP3,S100A8)were selected to construct the prognostic model.Significant differences in immune cell activation and immune-related signaling pathways were observed between the high-risk and low-risk groups based on tumor microenvironment analysis(all P<0.05).Additionally,characteristic genes within the osteosarcoma microenvironment were identified in regulation of intercellular crosstalk through the GAS6-MERTK signaling pathway. Conclusion:The prognostic model based on ANRGs and tumor microenvironment demonstrate good predictive power and provide more personalized treatment options for patients with osteosarcoma.

Objective To explore the pain catastrophizing (PC) level of pain in patients with multiple fractures and its influencing factors. Methods Eighty patients with mandibular fracture were selected and randomly divided into control group and observation group, with 40 cases in each group. The control group was conducted with routine postoperative nursing measures, while the observation group was conducted with additional evidence-based nursing intervention. The recovery status, incidence of postoperative complications, mental health status, and nursing satisfaction degree were analyzed in both groups. Results The wound healing time was (7.90±4.21) days in the observation group and (9.43±4.29) days in the control group; the recovery efficiency of chewing function was (79.19±4.74) % in the observation group and (73.28±4.78) % in the control group; the incidence of complications was 7.5% in the observation group and 27.5% in the control group; the score of the Hamilton Anxiety Scale (HAMA) at 6 months after surgery was (10.76±1.65) points in the observation group and (13.99±1.43) points in the control group; score of the Hamilton Depression Scale (HAMD) at 6 months after surgery was (11.78±1.26) points in the observation group and (12.49±1.29) points in the control group; all the between-group differences mentioned above were statistically significant (P<0.05). Conclusion Evidence-based nursing can promote the postoperative recovery of patients with mandibular fracture, reduce the incidence of postoperative complications, alleviate patient's psychological stress, and increase nursing satisfaction degree.

This article started from the definition of unavoidable stress injury, analyzed the mechanism of occurrence and the current development of unavoidable pressure injury assessment methods and assessment tools, discussed the limitations of the current differential assessment of unavoidable stress injury, and putted forward relevant suggestions to provide reference for the research on the assessment and prevention strategies of unavoidable pressure injury in China.

Objective:To evaluate the protective effect of foam dressing in preventing intraoperative acquired pressure injury (IAPI), and to provide reference basis for prevention and treatment of IAPI during clinical operation.Methods:The clinical data of 455 surgical patients admitted to Xinhua Hospital Affiliated to Shanghai Jiao Tong University from October 2020 to January 2021 were retrospectively collected. According to whether foam dressing was used at the compression site during operation, the patients were divided into dressing group (101 cases) and control group (354 cases). The two groups were matched with age, body mass index, preoperative Braden and cerebrovascular disease as covariates, and were finally divided into 89 patients in the dressing group and 162 patients in the control group. Logistic regression analysis and stratified analysis were used to comprehensively evaluate the actual effect of foam dressing on the occurrence of IAPI in the surgical patients.Results:Among the 251 patients, there were 14 (15.7%) cases with IAPI in the dressing group and 13 (8.0%) cases in the control group, and the difference was not statistically significant ( χ2=3.41, P>0.05). Among the patients in the prone position, compared to the control group, the dressing group can effectively reduce the risk of IAPI in surgical patients by 77% ( OR=0.23, 95% CI 0.05-0.98, P<0.05). There was no interaction between foam dressing and intraoperative surgical characteristics ( P>0.05). Conclusions:Foam dressing plays a protective role in preventing the occurrence of IAPI in patients undergoing surgery in the prone position. There was no significant protective effect of intraoperative foam dressing in patients with other surgical characteristics.

Objective:To evaluate the effect of esmketamine for labor analgesia on the occurrence of postpartum depression (PPD).Methods:Two hundred and forty-two cases of nulliparous parturients who selected natural labor and agreed to receive labor analgesia were selected and divided into conventional labor analgesia group (C-LA group, n=119) and esmketamine-based labor analgesia group (E-LA group, n=123). The epidural labor analgesia solution contained ropivacaine 100 mg and sufentanil 30 μg in 100 ml of normal saline in C-LA group. The epidural labor analgesia solution contained ropivacaine 100 mg, sufentanil 30 μg and esketamine 50 mg in 100 ml of normal saline in E-LA group. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen parturients for depression on admission to the predelivery room and at 2 h and 1, 7 and 42 days after delivery, and EPDS scores were recorded. The patients were diagnosed as having PPD when EPDS score ≥ 9 at 7-42 days after delivery. Peripheral venous blood samples were collected on admission to the predelivery room and at 1 day after delivery to determine the concentrations of serum estrogen, progesterone, 5-hydroxytryptamine and cortisol by enzyme linked inmunosorbent assay. Results:Compared with group C-LA, the EPDS scores were significantly decreased on the 1 and 42 days after delivery( P<0.01), no significant change was found in the incidence of PPD (1.7%/0.8%, P>0.05), no significant change was found in the concentrations of serum estrogen, progesterone, 5-hydroxytryptamine and cortisol on admission to the delivery room ( P>0.05), and the concentrations of serum progesterone and cortisol were significantly increased on 1 day after delivery in group E-LA ( P<0.05). Conclusions:Combination of esketamine is helpful in reducing the risk of postpartum depression when used for epidural labor analgesia, and the mechanism is related to slowing the declines in blood levels of sex hormones and stress hormones after delivery.