Objective:To explore the organizational identity, sense of coherence, perceived social support, and work engagement of surgical nurses in a traditional Chinese medicine hospital and the relationships between them.Methods:From March to May 2022, 450 surgical nurses were selected by convenience sampling from Guangdong Provincial Hospital of Traditional Chinese Medicine for a survey with a general information questionnaire, the Organizational Identification Scale, the Sense of Coherence Scale, the Perceived Social Support Scale, and the Utrecht Work Engagement Scale-9. SPSS 24.0 was used to perform Pearson correlation analysis. AMOS 24.0 was used for structural equation modeling.Results:The nurses' scores of organizational identity, sense of coherence, perceived social support, and work engagement were (26.00±5.00), (53.58±7.50), (47.47±7.50), and (30.06±1.00), respectively. The correlation analysis revealed positive correlations between organizational identity, sense of coherence, perceived social support, and work engagement ( r=0.369-0.741, all P<0.001). Sense of coherence played a partial mediating role between perceived social support and work engagement, and the mediating effect was 0.07, accounting for 12.07% of the total effect. Organizational identity and sense of coherence produced a chain mediating effect between perceived social support and work engagement, in which the mediating effect was 0.11, accounting for 18.97% of the total effect. Conclusions:Organizational identity and sense of coherence produce a chain mediating effect between perceived social support and work engagement in the surgical nurses of the traditional Chinese medicine hospital.

Objective:To explore the application of observation teaching discussion (OTD) in vascular surgery nursing intern teaching under the guidance of process-oriented guided inquiry learning (POGIL) theory.Methods:Forty nursing students who were doing their internship in The First Affiliated Hospital of Xi'an Jiaotong University from July 2022 to July 2023 were randomly divided into two groups using a random number table: control group (20 students, OTD teaching) and observation group (20 students, POGIL theory-guided teaching) . The two groups were compared for competence assessment scores before entering the department and 3 days prior to departure from the department, autonomous learning ability scale scores, Competency Inventory for Registered Nurses (CIRN) scores, and Chinese Problem Solving Inventory (CPSI) scores. T-tests and chi-square tests were conducted using SPSS 22.0. Results:Three days prior to departure from the department, the theoretical performance and practical performance were significantly better in the observation group [(91.67±5.22) and (89.69±4.36) points, respectively] than in the control group [(84.53±4.75) and (82.41±4.18) points, respectively] ( P<0.05). The observation group also performed significantly better than the control group in autonomous learning ability scale score [(139.52±13.52) vs. (128.86±10.76)], CIRN score [(207.73±6.23) vs. (195.67±5.98)], and CPSI score [(103.60±4.72) vs. (92.18±5.03)] (all P<0.05). Conclusions:The application of OTD in vascular surgery nursing intern teaching under the guidance of POGIL theory can improve the autonomous learning ability, core ability, and problem-solving ability of nursing interns.

Objective To compare the efficacy and safety of anlotinib(AL)and bevacizumab(BEVA)in the treatment of advanced lung adenocarcinoma(LUAD)with acquired resistance to epidermal growth factor receptor-tyrosine kinase inhibitors(EGFR-TKI).Methods The clinical data of patients with EGFR-TKI-resistant LUAD who were treated in the Department of Oncology of Yibin Third People's Hospital from January 2022 to January 2023 were retrospectively analyzed.According to the treatment plan,patients were divided into BEVA group and AL group.Both groups were treated with BEVA injection or AL capsule in combination with standard chemotherapy for a total of 4 cycles.The main outcome measures included changes in tumor marker levels[carcinoembryonic antigen(CEA),neuron-specific enolase(NSE),and vascular endothelial growth factor(VEGF)],recent clinical efficacy[overall response rate(ORR)and disease control rate(DCR)],progression-free survival(PFS),1-year survival rate,and drug-related adverse reactions.Results A total of 60 patients with EGFR-TKI-resistant LUAD were included in the study,including 32 patients in the BEVA group and 28 patients in the AL group.After four cycles of treatment,the levels of serum CEA,NSE,and VEGF in both groups significantly decreased,and AL group was lower than BEVA group(P<0.05).There were no significant statistical differences in the complete remission rate,partial remission rate,disease stability rate,and ORR between the two groups(P>0.05).Compared with the BEVA group,the AL group had a lower rate of disease progression(P<0.05)and a higher DCR(P<0.05).In addition,the median PFS in the BEVA group was significantly longer than that in the AL group(8.4 vs.7.2 months,P<0.05),while there was no significant difference in survival rate between the two groups(P>0.05).In terms of adverse reactions,patients in the AL group had a lower incidence of nausea and vomiting,but a higher incidence of bone marrow suppression,resulting in a lower overall adverse reaction grade.Conclusion Compared with the BEVA combination chemotherapy regimen,AL combination chemotherapy showed better efficacy and good safety in the treatment of EGFR-TKI-resistant advanced LUAD.

Objective:To study the clinical characteristics and risk factors of nephrocalcinosis in preterm infants.Methods:From March 2021 to August 2021, all preterm infants admitted to NICU of our hospital were retrospectively analyzed. The infants were assigned into nephrocalcinosis group and non-nephrocalcinosis group according to urinary tract ultrasound. Clinical data including gestational age, birth weight(BW), nutritional support strategy and complications were reviewed.Results:A total of 40 preterm infants (<34 weeks) were enrolled. 9 cases were in the nephrocalcinosis group and 31 cases in the non-nephrocalcinosis group. The nephrocalcinosis group had lower BW[(1 167±214) g vs.(1 586±215) g], higher calcium [6.9 (5.1, 8.7) g vs.3.3 (2.1, 6.8) g] and vitamin D intake [3.2(2.5, 4.2)×10 4U vs.1.7(1.1, 3.2)×10 4U] during hospitalization. No significant differences existed between the two groups on the following items:blood calcium and phosphate, 25-hydroxyvitamin D, feeding strategy, time to reach full enteral feeding(TFF), furosemide dosage and respiratory support duration ( P>0.05). In the nephrocalcinosis group, the median age of diagnosing nephrocalcinosis was 40.0(30.0, 52.5)d after birth. 5 cases showed bilateral nephrocalcinosis. 5 cases in the nephrocalcinosis group received renal tubule function examination,4 cases had increased urine β2 microglobulin and 2 cases had increased urine α1 microglobulin. 7 cases had elevated urine calcium in the nephrocalcinosis group. Follow-up showed that nephrocalcinosis disappeared 3-9 months after birth. Conclusions:BW, total calcium and vitamin D intake are risk factors for nephrocalcinosis in preterm infants. Increased urine β2 microglobulin and calcium levels are common co-morbidities in preterm infants with nephrocalcinosis.

Objective:To explore the application of effect of healthcare failure mode and effect analysis (HFMEA) in emergency waiting risk management.Methods:From May 2020 to April 2021, totally 87 902 emergency waiting patients from the First Affiliated Hospital of Anhui Medical University were assigned to control group by cluster sampling method. From May 2021 to April 2022, 80 594 emergency waiting patients were assigned to observed group. The patients in the control group received routine emergency waiting of itinerant management mode. In contrast, the patients in the observed group received emergency waiting risk management mode based on HFMEA. The process risk priority number (RPN) and waiting risk management index between two groups were compared.Results:The mean RPN of the observed group was (98.48 ± 8.27) points, significantly lower than that of the control group (251.27 ± 16.95) points. The nurses′ pre-identification rates of changes in the condition and adverse reaction in the observed group were 10.77%(8680/80 594) and 13.37%(10 775/80 594), which were higher than those in the control group, 5.77%(5072/87 902) and 8.12%(7134/87 902), the differences were statistically significant ( χ2 values were 1402.32 and 1221.66, all P<0.05). Conclusions:The application of HFMEA to optimize the emergency waiting management process can effectively reduce the risk of emergency waiting and improve the quality of emergency waiting management.

Objective:To investigate the effect of deescalation noninvasive positive pressure ventilation in the removal of endotracheal intubation in patients with Stanford type A aortic dissection (AAD) complicated with obesity.Methods:A total of 80 obese patients with AAD from March 2018 to January 2020 in the First Affiliated Hospital of Xi′an Jiaotong University were divided into experimental group and control group with 40 cases in each group by random number table method. The control group received traditional oxygen treatment with mask, while the experimental group received de-escalation noninvasive positive pressure ventilation. The blood gas index, respiratory rate and respiratory comfort score was recorded at different times before and after intervention, make a comparison with the two groups in the incidence of hypoxemia, secondary intubation and other complications.Results:Finally, 36 cases were included in the experimental group and 38 cases in the control group. After 2, 8, 24, 48, 72 h of extubation, the oxygenation index, PaO 2, SaO 2 were higher and PaCO 2, respiratory rate were lower in the experimental group compared to the control group, the differences were statistically significant ( t values were 2.02-9.00, all P<0.05). At 72 h after extubation, the pH value of the experimental group was 7.43 ± 0.08, which was higher than 7.38 ± 0.09 of the control group, and the difference was statistically significant ( t=2.44, P<0.05). At 24, 48, 72 h after extubation, the throat pain scores and oral nasal dryness symptom and sore throat symptom scores were (3.11 ± 1.53), (2.25 ± 0.57), (0.94 ± 0.14) points and (4.33 ± 1.08), (3.33 ± 0.68), (2.81 ± 0.43) points in the experimental group, lower than in the control group (5.24 ± 1.96), (3.58 ± 0.73), (2.18 ± 0.91) points and (6.00 ± 1.92), (5.39 ± 1.13), (4.79 ± 0.54) points, the differences were statistically significant ( t values were 3.46-5.21, all P<0.05). The incidence of hypoxemia, secondary intubation and intolerance were 2.8% (1/36), 2.8% (1/36) and 0 in the experimental group, lower than in the control group 26.3% (10/38), 21.1% (8/38) and 10.5% (4/38), the differences were statistically significant ( χ2=8.09, 5.78, 4.01, all P<0.05). Conclusions:De-escalation noninvasive positive pressure ventilation for obese patients with AAD can effectively improve oxygenation, reduce the incidence of hypoxemia and secondary intubation, and alleviate respiratory symptoms.

Anaphylaxis is increasingly in children, which is currently undernotified, underdiagnosed, and undertreated in China.In order to further improved the understanding and management of anaphylaxis, this issue reviews the pathogenesis, triggers and risk factors, clinical diagnosis and management of anaphylaxis, thus offers the recommedations of anaphylaxis in Chinese children based on previous published evidence-based guidelines and practice parameters.Recommendation aims to develop guiding principles for the diagnosis and management of anaphylaxis in children, and provide a framework for the development of new guidelines.

Objective:To observe the long-term effects of conventional disease modifying anti-rheumatic drugs (cDMARDs) in the treatment of ankylosing spondylitis (AS) and drug-related adverse reactions, and provide reference to clinical treatment and assessment.Methods:Retrospective analysis was performed for AS patients with more than 10 years follow-up records in the Department of Rheumatology and Immunology, Peking University Shenzhen Hospital. The AS patients enrolled were treated with cDMARDs, non-steroid anti-inflammatory Drugs (NSAIDs), and glucocorticoidsonl only. The treatment group was treated continuously for at least 3 years, and the control group was untreated or treated for less than 3 months. Clinical symptoms, inflammatory indicators, imaging results and drug-related adverse reactions of all patients were collected for statistical analysis. The counting data were tested by χ2 test, the measurement data in normal distribution was tested by t test, and the measurement data that not normally distributed was tested by mann-whitney U test. Paired test was used for statistical processing before and after treatment. Results:A total of 166 eligible patients were included, including 111 in the treatment group and 55 in the control group. There were no statistical significant differences between the treatment group and the control group at baseline including the mean follow-up time, symptomatic disease course, age, sex ratio, human lymphocyte antigen (HLA)-B27 positive rate, duration of morning stiffness, pain at night, peripheral arthritis, ESR, CRP and imaging data. After 10 years, the treat-ment group had shorter morning stiffness[(8±18) vs (22±34), U=2 228, P=0.008], less nocturnal pain [(2/1.9%) vs (19/36.5%), χ2=37.037, P<0.01], lower ESR level [(14±13) vs (20±19), t=2.249, P=0.026], lower CRP level [(6±6) vs (10±11), t=2.154, P=0.033], lower incidence of peripheral arthritis [(23/20.7%) vs(25/45.5%), χ2=10.946, P=0.001] and lower sacroiliac arthritis progression rate [(28/25.2% ) vs (46/83.6%), χ2=50.922, P<0.01], and lower spinal progression rate [(8/7.2%) vs (51/92.7%), χ2=117.407, P<0.01] compared with the control group. The differences between the two groups was statistically significant. The main medications and drug proportions in the treatment group were as follows: sulfasalazine (100%), methotrexate (86.5%), NSAIDs (98.2%), glucocorticoid (78.4%) and thalidomide (62.2%). The main drug-related adverse reactions that occurred during the treatment included dizziness, abnormal menstruation, and reversible liver dysfunction. Conclusion:The combination of cDMARDs can effectively control the clinical symptoms of most AS patients, reduce inflammation indicators, delay the progression of sacroiliac joint and spinal damage, and have no serious drug-related adverse reactions. Almost all of the untreated AS patients have radiographic progression of the sacroiliac joint and spine.

Objective To observe the clinical characteristics of ankylosing spondylitis (AS) patients with hyperuricemia (HUA), and to understand the correlation between AS and HUA, so as to improve the understanding of AS patients with HUA. Methods A retrospective analysis was carried out in patients with the diagnosis with AS from November 2012 to August 2016. Patients were divided into two groups based on complicated with and without HUA. The clinical manifestations, inflammatory indicators, imaging manifest-ations, treatment and outcomes of the two groups were statistically analyzed, and the follow-up results of some patients with HUA were analyzed. The chi-square test was used for the counting data. The measurement data in line with the normal distribution were tested by t test, and the measurement data in non-normal distribution were tested by Mann-Whitney U test. Results Three hundred and sixty-two patients with AS were collected, consisting of 288 males (79.6％) and 74 females (20.4％), aged from 14 to 72 years, a course of disease was 3 months to 40 years. There were 87 cases (24.0％) with hyperuricemia, 77 cases were male (88.5％, 21.3％of all AS patients), and 10 were female (11.5％, 2.8％ of all AS patients). Shorter morning stiffness time [(13 ±31) min and (22 ±48) min, Z=-2.231, P=0.026], lower IgM level [(1.4 ±1.3) g/L and (3.0 ±4.3) g/L, Z=-2.040, P=0.041], and lower erythrocyte sedimentation rate [(25±17) mm/1 h and (33±22) mm/1 h, t=-2.617, P=0.007] in the HUA group when compared with patients without HUA. The difference between the two groups was statistically significant. Four cases (4.6％) had gout arthritis in the group with HUA, all were male, blood uric acid level all>420 μmol/L. There were 7 cases (8.0％) of urolithiasis in the group with HUA, and 24 cases (8.7％) of urolithiasis in the group without HUA, but there was no statistically significant difference in the incidence of urolithiasis between the two groups. None developed hypertensive disease, heart disease, nephropathy, or diabetis. Conclusion The incidence of hyperuricemia is high in AS, and with lower disease activity, and fewer complications.

Objective To analyze the expression of peripheral blood CD13+CD4+CD25hi regulatory T cells (Treg cells) in patients with diffuse large B-cell lymphoma (DLBCL) and its clinical significance. Methods The expression of peripheral blood CD13+CD4+CD25hi Treg cells in 58 newly diagnosed patients with DLBCL and 30 healthy adults was detected by flow cytometry, and the relationship between its expression and the clinical indicators were analyzed statistically. Results The levels of peripheral blood CD13+CD4+CD25hi Treg cells in newly diagnosed DLBCL and healthy adults were different, with statistically significant difference [(36.37 ±11.89) % vs. (9.03 ±2.10) %, t = 7.168, P < 0.001]. The level of peripheral blood CD13+CD4+CD25hi Treg cells was significantly higher in patients with IPI score 3ˉ5 than that in patients with IPI score 0ˉ2[(44.28±10.10)%vs. (21.51±6.23)%, t=ˉ9.347, P=0.03]. The expression of peripheral blood CD13+ CD4+ CD25hi Treg cells in stages Ⅱ, Ⅲ and Ⅳ patients were (19.48 ±1.34) %, (33.98 ±8.03) % and (47.89±8.25) %respectively, and there were significant differences among three groups (F= 38.363, P<0.001). The levels of peripheral blood CD13+CD4+CD25hi Treg cells had no relationship with age, sex or LDH level (all P>0.05). Conclusion The levels of peripheral blood CD13+CD4+CD25hi Treg cells are higher in DLBCL patients, which has a close relationship between the expression of CD13+CD4+CD25hi Treg cells and clinical stage and prognosis.