From the perspective of palliative care， focusing on the entire process surrounding the death of terminally ill children， with an emphasis on the value of death for children. It explores the children’s understanding of death and the process of self-value pursuit， elucidating the construction of the value of death. Furthermore， it interprets the multifaceted implications of the value of death for children from three dimensions： terminally ill children， caregivers， and society. Additionally， it explores the role of the construction of the value of death in achieving a good death for terminally ill children， optimizing care models， and accelerating the formation of a societal environment of good death， as so to enhance contemporary society’s understanding and appreciation for the value of death for children， bridging the gap in pediatric palliative care and providing a theoretical basis for improving the quality of life for terminally ill children.

Objective:To investigate the promoting effect of individualized instruction combined with a blended learning model (IIBLM) in continuing training of neurology.Methods:A total of 93 trainees who received continuing training in Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, from August 2022 to December 2024 were enrolled as subjects. The 50 trainees registered since January 2024 were enrolled as observation group and received IIBLM teaching, including sub-specialty modular training, a cycle-adaptive cultivation system, a "mutual-selection" mentorship program, an on/off-line dual-track curriculum system, a dynamic course allocation mechanism based on "mutual selection", and a competency growth evaluation system, while the 43 trainees registered before January 2024 were enrolled as control group and received traditional teaching. A questionnaire survey and comprehensive competency assessments were performed to evaluate the effect of teaching, and the t-test, the chi-square test, and the qualitative analysis were used for statistical analysis. Results:Compared with the control group, the experimental group showed systematic improvements in clinical contents, theoretical curriculum, faculty competency, and workflow arrangement during continuing training, with a significant difference in the score of workflow arrangement between the two groups [(9.58±0.67) vs. (9.07±1.44), t=-2.13, P=0.037]. The observation group had a score of (97.70±1.30) for dynamic course allocation, an overall satisfaction rate of 97.15%, and a course benefit rate of 97.55%. The qualitative analysis showed that the trainees in the control group mainly complained of course monotony, while those in the observation group expected to enhance interdisciplinary integration and the cultivation of scientific research abilities. In addition, the results of competency assessment showed a continuous improvement in teaching effect after reform, with no significant difference. Conclusions:IIBLM teaching effectively enhances professional qualities, clinical competency, and the degree of satisfaction with courses among the trainees receiving continuing training, and it also revealed the necessity of interdisciplinary collaborative teaching and the integration of research and clinical practice.

Objective:To investigate the promoting effect of individualized instruction combined with a blended learning model (IIBLM) in continuing training of neurology.Methods:A total of 93 trainees who received continuing training in Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, from August 2022 to December 2024 were enrolled as subjects. The 50 trainees registered since January 2024 were enrolled as observation group and received IIBLM teaching, including sub-specialty modular training, a cycle-adaptive cultivation system, a "mutual-selection" mentorship program, an on/off-line dual-track curriculum system, a dynamic course allocation mechanism based on "mutual selection", and a competency growth evaluation system, while the 43 trainees registered before January 2024 were enrolled as control group and received traditional teaching. A questionnaire survey and comprehensive competency assessments were performed to evaluate the effect of teaching, and the t-test, the chi-square test, and the qualitative analysis were used for statistical analysis. Results:Compared with the control group, the experimental group showed systematic improvements in clinical contents, theoretical curriculum, faculty competency, and workflow arrangement during continuing training, with a significant difference in the score of workflow arrangement between the two groups [(9.58±0.67) vs. (9.07±1.44), t=-2.13, P=0.037]. The observation group had a score of (97.70±1.30) for dynamic course allocation, an overall satisfaction rate of 97.15%, and a course benefit rate of 97.55%. The qualitative analysis showed that the trainees in the control group mainly complained of course monotony, while those in the observation group expected to enhance interdisciplinary integration and the cultivation of scientific research abilities. In addition, the results of competency assessment showed a continuous improvement in teaching effect after reform, with no significant difference. Conclusions:IIBLM teaching effectively enhances professional qualities, clinical competency, and the degree of satisfaction with courses among the trainees receiving continuing training, and it also revealed the necessity of interdisciplinary collaborative teaching and the integration of research and clinical practice.

Objective:To investigate the clinical efficacy of transfer of a free segment of the proximal second toe interphalangeal joint composite tissue flap in reconstruction of defects of interphalangeal joint of fingers, and simultaneously reconstruct the donor site defect left with the second toe by a transfer of a pedicled bone flap of the fibular proximal great toe.Methods:From December 2020 to April 2023, a total of 9 patients with interphalangeal joint defects of fingers were treated in the Department of Hand Microsurgery of Shunde Heping Surgery Hospital. The patients were 7 males and 2 females, aged 18-55 years old, with an average age of 31 years old. Firstly, transfers of a free segment of the proximal second toe interphalangeal joint composite tissue flap were performed to reconstruct the defects of finger joints. Simultaneously in the surgery, transfers of the fibular pedicled bone flap of the proximal great toe were conducted to reconstruct the donor site defects left in the second toe. Patients were instructed with appropriate postoperative functional exercises. K-wires were removed at 8-12 weeks after surgery. Outpatient visits, telephone and WeChat follow-ups were conducted to evaluate the appearance and functional recovery of the reconstructed interphalangeal joints and donor feet. Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, Vancouver Scar Scale (VSS) and American Orthopedic Foot and Ankle Society (AOFAS) foot function scoring standards were employed in the evaluation.Results:Postoperative follow-up lasted for 6 to 30 months. All of the 9 interphalangeal joint composite tissue flaps in the fingers survived with complete and good appearance. Function of the reconstructed interphalangeal joints of the fingers recovered well. According to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, the average score achieved 12 points, with 6 patients of excellent, 2 of good and 1 of fair. After surgery, the appearance and function of the donor great toes and second toes all recovered well. The average score of the scars in donor second toe evaluated by VSS was 4 points. All the donor feet were kept with 5 toes, with full, intact and good in appearance. According to the AOFAS foot function scoring standard, the average score achieved 95 points, and were excellent.Conclusion:Application of transfer of free proximal segment of interphalangeal joint composite tissue flap of the second toe in reconstruction of the interphalangeal joint defect of a finger, and simultaneously reconstruct the defect left with the donor second toe with a fibular proximal great toe flap pedicled with bone tissue can achieve good clinical efficacy in reconstruction of the defects of interphalangeal joint of fingers, restore the function of the interphalangeal joint of fingers and the appearance and function of the donor foot.

From the perspective of hospice care,focusing on the entire process before and after the occurrence of a death event,taking the interpretation of the concept of death value in hospice care as the starting point,this paper explored the value connotation implied in the process of death from the perspectives of the terminal person,caregivers,and social culture,as well as summarized the characteristics of the death value.Meanwhile,in the current social context of the difficulty in achieving good death due to the shallow understanding of death,this paper analyzed the great significance of the construction of the death value concept in hospice care for improving the personal death quality of the terminal person,promoting the quality of end-of-life,and accelerating the formation of a social environment of good death,with a view to stimulating academic attention to the construction of the death value of terminal person,and providing conceptual reference for improving the quality of hospice care services.

Focusing on the field of palliative care，the Rodgers evolutionary concept analysis method was used to analyze the literature related to good death in the context of Chinese culture.The development history and application，definition and characteristics，influencing factors and their impacts，measuring indicators and tools of the concept of good death were elaborated，and further discussions were conducted.Good death refers to an individual’s peaceful and painless journey towards death，without subjective pain or concern，and calmness under the premise of sufficient longevity，while receiving care and companionship during the process of death from family，especially children and grandchildren，as well as achieving moral fulfilment and transcendence.The characteristics of good death in the context of Chinese traditional culture include the indirect expression of physical and mental pain being “understood” and properly handled，the construction of dying dignity based on virtue rather than autonomy，the emphasis on filial piety and emotional connections in the family，making after-death arrangements and realizing intergenerational inheritance，as well as the emphasis on achieving the integrity of life at the moment of death，which have distinct Chinese cultural characteristics.In the future，the connotation and extension of the concept of good death should be further explored，so as to assist in the development of localized theory and practice systems of good death.

Objective:Based on the theory of planned behavior (TPB), the exercise intervention program for breast cancer patients undergoing chemotherapy was constructed, and its application effect was preliminarily explored.Methods:A total of 116 patients receiving chemotherapy in the department of breast surgery from June to December 2021 in Shanxi Provincial Cancer Hospital were selected by purpose sampling method. The subjects were randomly divided into control group and experimental group by flipping a coin. The control group was given routine nursing, and the experimental group was given routine nursing on the basis of exercise intervention based on the theory of planned behavior. After three cycles of chemotherapy, the effects of the intervention were evaluated by piper Revised Fatigue Scale (RPFS), Exercise Self-efficacy Scale and Quality of Life Core Scale (EORTC QLQ-C30).Results:In the intervention stage, there were 2 cases in the experimental group and 3 cases in the control group lost. After the intervention, the total score and all dimensions (behavioral, emotional, sensory and cognitive) of cancer-induced fatigue in the experimental group were (2.30 ± 0.58), (2.21 ± 0.85), (2.32 ± 0.70), (2.66 ± 0.71) and (2.03 ± 0.58), which were lower than those in the control group (2.84 ± 0.44), (2.79 ± 0.60), (3.04 ± 0.75), (3.04 ± 0.60) and (2.53 ± 0.56), the differences were significant ( t values were 3.05-5.23, all P<0.05). The total scores of exercise self-efficacy and the dimensions of physical, psychological and social environment were higher than those of the control group ( t values were -7.63 - -3.31, all P<0.05). The scores of overall quality of life, physical function and emotional function were higher than those of the control group ( t = -3.48, -3.14,-2.34, all P<0.05), while the scores of fatigue and insomnia symptoms were lower than those in the control group ( t = 5.13, 3.14, both P<0.05). Conclusion:The exercise program based on the theory of planned behavior can improve the exercise self-efficacy of breast cancer patients undergoing chemotherapy, reduce cancer-related fatigue and improve their quality of life.

Objective: To explore the method of replanting severed piercing finger micro tissue blocks. Methods: From February, 2001 to October, 2016, 16 cases of severed piercing finger micro tissue blocks were replanted with debridement. The trunk or branch of proper palmar digital artery was anastomosed. Vascular collocations were used such as venous arterialization when there was no anastomotic artery available. Regular postoperative followed-up was performed to observe the recovery of tissue survival, appearance, sensation of flap, and joint function. Results: One case had partial epidermal necrosis, and healed after change of dressing. The finger-disconnected micro tissue blocks of other 15 cases survived well. After 6 months to 2 years of follow-up, the replanted micro tissue blocks were ruddy in color and recovered from S₃ to S₄. The appearance of the 16 fingers was good, and the function of joints was restored. Conclusion The finger-disconnected micro tissue blocks should be actively replanted. With skilled microsurgical techniques, the anastomosis of the arterial or venous artery will ensure the success of replantation and survived, as well as to restore good function and appearance.

OBJECTIVE:To investigate the effect of Saccharomyces boulardii adjuvant with aluminium phosphate on symp-toms and signs disappearance time,immune function and inflammatory factors in children with acute diarrhea. METHODS:Totally 110 children with acute diarrhea were chosen from our hospital during Mar. 2013-Mar. 2016,and then randomly divided into con-trol group and observation group according to random number table,with 55 cases in each group. Control group was given Alumini-um phosphate gel 2.5 g,po,qd,on the basis of conventional treatment. Observation group was additionally given S. boulardii cap-sules 0.25 g,po,bid,on the basis of control group. Both groups were treated for 3 d. Clinical efficacies,symptoms and signs(di-arrhea,abdominal pain,vomiting,abnormal stool routine)disappearance time as well as stool frequency,stool character scores, immune function indexes(CD3+,CD4+,CD8+,CD4+/CD8+),inflammatory factors(IL-6,IL-10,TNF-α)before and after treat-ment,the occurrence of ADR were compared between 2 groups. RESULTS:The total response rate of observation group (90.91%)was significantly higher than that of control group(70.91%);the symptoms and signs disappearance time was signifi-cantly shorter than control group,with statistical significance(P<0.05). Before treatment,there was no statistical significance in stool frequency,stool character scores,immune function indexes or inflammatory factor levels between 2 groups(P>0.05). After treatment,stool frequency,stool character scores and inflammatory factor levels of 2 groups were significantly lower than before, and the observation group was significantly lower than the control group;the levels of CD3+,CD4+,CD4+/CD8+ were significantly higher than before treatment and control group,and the level of CD8 + was significantly lower than before treatment and control group,with statistical significance(P<0.05). There was no significant difference in immune function indexes of control group be-fore and after treatment(P>0.05). Total incidence of dry mouth and constipation was 5.45% in control group and 9.09% in obser-vation group,without statistical significance(P>0.05). CONCLUSIONS:S. boulardii adjuvant with aluminium phosphate in the treatment of pediatric acute diarrhea can efficiently improve symptoms and signs,shorten disease duration,improve immune func-tion and reduce inflammatory reaction with good safety.

Objective To observe the clinical effects of dermis combined autologous transplants in patients with abnormal scar thickness skin graft.Methods 13 cases of scar deformity were selected during August 2011 to December 2014 in our hospital.In stage 1 procedure,the scars that affected the function and induced deformities were resected and then the artificial dermis covering the wound was placed;in stage 2,two weeks after the artificial dermis vascularization,autologous skin grafts were removed to repair the wound edge.Meanwhile,therapy of inhibiting scar after conventional treatment was conducted with funcitional exercise.Results 13 cases were scheduled to repair scar wounds,underwent surgery with more than 6 months follow-up observation.The dysfunctions caused by scar contracture and deformity were significantly improved;appearance,elasticity and appearance of the skin grafts were similar to autologous skin graft with the desired clinical effect.Conclusions Artificial dermis combined autologous skin graft treatment of patients with scar deformity can achieve similar clinical effects to traditional treatment methods.