ObjectiveTo explore the effectiveness of feedforward control mode on improving occupational burnout among operating room nurses through theoretical research and clinical practice， with a view to promoting their physical and mental health and enhancing the quality of surgical nursing. MethodsA total of 440 operating room nurses from different regions， scales， and nursing experiences in Shaanxi Province from November 2023 to December 2023 were randomly divided into an experimental group and a control group， with 220 nurses in each group. While the control group received routine intervention measures， the experimental group introduced a feedforward control mode based on the control group， with “emotional exhaustion，” “depersonalization，”and“personal achievement” as observation indicators. ResultsThe incidence of occupational burnout in the experimental group was 11.4%， while that in the control group was 20.0%. The experimental group showed a significantly lower incidence than the control group （P=0.013）. ConclusionThe feedforward control mode can significantly alleviate nurses’ sense of job burnout， promote the improvement of surgical nursing quality， as well as continuously improve the scientific rigor， advancement， and humanistic nature of nursing services， which is conducive to building a harmonious and efficient nursing team. The spirit of teamwork， reflected in mutual support， mutual trust， and joint efforts for surgical success and patient health， has become an important component of nurses’ professional ethics.

Objective:To explore the outcomes and problems of the Beijing Nursing Association Emergency Specialist Nurse Training Course, so as to provide reference for improving the training of emergency specialist nurses.Methods:Convenience sampling was used to select 75 trainees from the 2023 Beijing Nursing Association Emergency Specialist Nurse Training Course as survey subjects. Beijing Nursing Association Emergency Specialist Nurse Training Scoring Criteria was used to score trainees from four aspects of theoretical knowledge, skill operation, case analysis, and review defense, and to summarize and analyze the existing problems.Results:A total of 75 questionnaires were distributed, and 75 valid questionnaires were collected, with a valid response rate of 100.0%. The theoretical knowledge score was (68.4±10.7), with a minimum of 38.0 and a maximum of 91.0, and the pass rate (number of passing trainees divided by the total number of trainees) was 81.3%. The score for the review defense was (78.8±5.7), with a minimum of 65.0 and a maximum of 94.0, and a pass rate of 100.0%. The skill operation score was (93.5±3.7), with a minimum of 85.0 and a maximum of 99.0, and a pass rate of 100.0%. The score for the case analysis was (90.2±5.6), with a minimum score of 80.0 and a maximum score of 100.0, and a pass rate of 100.0%. The main reasons for losing points in the theoretical knowledge were mechanical ventilation and cardiopulmonary resuscitation. The main reasons for losing points in the review defense were topic selection and paper writing. The main reasons for losing points in skill operation were preparation before operation and key points after operation. The main reasons for losing points in the case analysis were the consultation ideas and treatment measures.Conclusions:The trainees of the emergency specialist nurse training course currently have a relatively good overall professional practical skills, but there are significant differences in theoretical knowledge, weak scientific research capabilities, and room for improvement in triage decision-making. It is suggested to give full play to the advantages of teachers and set up a variety of Internet courses for trainees to learn on their own to meet the personalized needs of trainees and improve teaching homogeneity.

This study was aimed at exploring the epidemiological characteristics of plague,and the evolutionary relation-ships among the isolated plague strains in the Yunnan border area,to provide clues for further studying epidemic causes and ep-idemiological patterns.Plague epidemic data in the border area during the second epidemic period(1982-2007)were collected and analyzed with descriptive epidemiological methods.Whole genome sequences of 262 strains of Yersinia pestis in the border area were obtained for phylogenetic analysis.Plague outbreaks occurred in 17 counties(cities)among 25 border counties(cit-ies);a total of 552 epidemic foci and 123 human cases were identified.The 1.ORI2,1.ORI3,1.IN3,2.ANT and 2.MED geno-types were identified among Yersinia pestis isolated from the Yunnan border area,among which the 1.ORI2 population was dominant.A total of 258 strains of Yersinia pestis from the 1.OR12 population belonged to four subclusters.The Myanmar and Vietnam clade was embedded within the Yunnan clade in the overall phylogeny.The above results indicated that during the sec-ond period of the epidemic,the intensity of plague epidemics in Yunnan's border areas was high,showing a trend of devel-opment from west to south and east.Our findings indicated a risk of cross-border transmission of plague between Yunnan and neighboring countries;therefore,the surveillance,pre-vention,and control of plague in border areas should be strengthened.

This study aimed to determine the drug resistance phenotype and genetic characteristics of Listeria monocytogenes ST5 LK100 isolated from a neonate,which provided a basis for the diagnosis and treatment of L.monocyto-genes infection and to enhance the understanding of the genomic characteristics of this strain.A suspected L.monocytogenes strain was isolated from the gastric juice sample of an infected neonate,and identified with a VITEK2 Compact automatic mi-crobial identification instrument and 16S RNA sequencing.Five drug sensitivity tests were conducted on the identified strain with the E-test method.Additionally,the whole genome of the strain was sequenced using a third-generation sequencing plat-form.The antibiotic resistance elements of the strain were identified by BlastN with the CARD antibiotic resistance gene data-base.The multilocus sequence typing(MLST),serotyping,and virulence genes of the strain was determined by Pasteur da-tabase,the virulence gene distribution was analyzed using the virulence analysis website.The prophages of the strain were predicted and annotate by PHASTER online website.The strain(LK100)isolated from the neonate was identified as L.monocytogenes.This strain was sensitive to penicillin,ampicil-lin,meropenem,erythromycin,and trimethoprim-sulfame-thoxazole antibiotics.The MLST type and serotype was ST5 and 1/2b-3b,respectively.The total length of the chromoso-mal genome of LK100 was 3 032 582 bp with a GC content of 37.91％,and it contained a complete circular plasmid with a se-quence length of 52 822 bp.The strain LK100 carried complete InlA protein,LIPI-1 pathogenicity island,SSI-1 stress survival island,and an LGI2 genomic island.The intrinsic antibiotic resistance genes were mainly located on the chromosome.Five prophage sequences were predicted in the LK100 genome.This study identified a strain of ST5 L.monocytogenes LK100 from an infected neonate and characterized its genome and antibiotic sensitivity,laying the foundation for further research on ST5 L.monocytogenes.

Objective:To investigate the efficiency and safety of the pulsatile GnRH therapy in the treatment of male congeni-tal hypogonadotropic hypogonadism(CHH).Methods:We retrospectively analyzed the clinical data on 45 CHH males treated by pulsatile GnRH therapy in our hospital from January 2013 to March 2023.We treated the patients with gonadorelin at 7-15 μg,one pulse/90 min,and followed them up every month in the first 3 months and then every 3 to 6 months after treatment,for an average of 19.1±4.3 months,during which we recorded the height,body weight,penile length,testis volume,Tanner stages,levels of FSH,LH and T,semen parameters and adverse reactions of the patients,followed by comparison of the data obtained with the baseline.Results:The levels of FSH,LH and T of the patients were dramatically elevated after treatment(P<0.01).The T level of the6 ca-ses of cryptorchidism,however,failed to reach the normal value within 18.2±8.6 months of follow-up.Significant improvement was seen in the external genitalia and secondary sexual characteristics of all the patients,and spermatogenesis was observed in the semen in 33 cases(73.3% ),with a mean sperm concentration of(18.2±6.2)106/ml,sperm progressive motility of(19.7±6.5)%,and semen volume of(1.8±0.6)ml.Eight of the cases achieved natural fertility,and another 3 achieved childbirth by assisted re-productive technology.As for adverse events,gynecomastia was observed in 8,subcutaneous induration in 6,and allergic reaction to therapeutic agent in 3 cases.Conclusion:Pulsatile GnRH therapy is an effective and safe strategy for male CHH.However,clini-cians should choose appropriate approaches to different individual cases.

AIM To investigate the effects of total Astragalus saponins on the improvement of sarcopenia in a rat model of type 2 diabetes mellitus(T2DM).METHODS The rats were divided into the normal group for a normal feeding and the model group for the feeding of high-sugar and high-fat diet combined with intraperitoneal injection of STZ to establish a T2DM model.The successful model rats were randomly divided into the model group,the metformin group(0.2 g/kg)and the total Astragalus saponins group(80 mg/kg),and given corresponding doses of drugs by gavage.After 12 weeks administration,the rats had their FBG,postprandial blood glucose(PG2h)and wet weight of skeletal muscle measured;their serum levels of INS,C-peptide(C-P),IGF-1,TNF-α and IL-1β detected by ELISA;their morphological changes of skeletal muscle observed by HE staining;their protein expressions of PI3K,p-Akt,mTOR,S6K1,FoxO1 and Murf1 in skeletal muscle detected by Western blot;and their mRNA expressions of Pi3k,Akt and mtor in skeletal muscle detected by RT-qPCR method.RESULTS Compared with the model group,the total Astragalus saponins group displayed decreased levels of FBG,PG2h,OGTT-AUC,HOMA-IR,TNF-α and IL-1β(P＜0.01);increased levels of INS,C-P,IGF-1 and wet weight of skeletal muscle(P＜0.05,P＜0.01);improved skeletal muscle atrophy and increased protein expressions of PI3K,p-Akt,mTOR and S6K1 in skeletal muscle(P＜0.05,P＜0.01);decreased protein expressions of FoxO1 and Murf1(P＜0.05,P＜0.01);and increased mRNA expressions of Pi3k,Akt and mtor(P＜0.01).CONCLUSION The improvement effects of total Astragalus saponins on sarcopenia in T2DM rats may be associated with the regulation of PI3K/Akt/mTOR and PI3K/Akt/FoxO1 pathways.

Objective To investigate the clinical features and prognosis of acute pancreatitis(AP)complicated with metabolic syndrome(MS).Methods 139 AP patients were retrospectively selected and divided into MS group(76 cases)and non-MS group(63 cases),general data of the two groups were collected and analyzed;conservative treatment was given to 2 groups of patients,and the general conditions,laboratory indicators,comorbidities,and related indicators of disease severity of the two groups were compared and analyzed,and the influencing factors of poor prognosis in patients(AP combined with MS)were analyzed.Results Compared with non-MS group,HDL,Ca2+in MS group decreased significantly,Body weight、Body Mass Index(BMI)、diabetes mellitus、hypertension(systolic/diastolic blood pressure)、hyperlipidemia、white blood cell count、CRP、PCT、IL-6、FPG、UA、TC、TG、TyG、TYG-BMI and non-traditional lipid parameters TC/HDL-C、TG/HDL-C、LDL-C/HDL-C and non-HDL-C were significantly increased.There were no significant differences in age、sex、length of stay、BUN、CREA、LDL-C、ALT and AST between the two groups(P＞0.05);BMI,white blood cell count,CRP,IL-6,FPG,UA,TC,TG,TyG,TYG-BMI,TC/HDL-C,TG/HDL-C,LDL-C/HDL-C,and non-HDL-C were independent risk factors for poor prognosis in AP patients with MS,and HDL-C was a potential protective factor for prognosis in AP patients with MS,the difference was statistically significant(P＜0.05).Conclusion With the change of modern lifestyle,there are more and more MS patients,and the incidence of MS patients with AP is gradually increasing.TyG,TYG-BMI and non-traditional lipid parameters are novel,convenient and practical markers for clinical evaluation,which have a high diagnostic and predictive value for AP with MS metabolic abnormalities,and provides clinical basis for management and intervention.

Objective To study the impact of a subject's testing state on residual noise level and ABR wave V amplitude during non-sedated ABR testing using Kalman-weighted averaging(KWA).Methods Twenty-one adults(18～34 years old,42 ears)with normal hearing were enrolled for non-sedated ABR testing under three different states(lying,sitting,and writing)in a quiet room using a new Kalman-weighted averaging ABR system(vivosonic integrity system).The residual noise level and the amplitude of wave V for click ABR(cABR)of each subject were recorded.The traditional ABR test system(interacoustics,IA)was also used to record ABR with the residual noise level and the amplitude of wave V measured at the same time.Results ① There was no significant difference in am-plitude of wave V between traditional ABR and non-sedated ABR in three different testing states(P＞0.05).②The residual noise levels in the lying and sitting states of KWA ABR were lower than those of traditional ABR,but there was no statistically difference(P＜0.05).The residual noise level of the KWA ABR system in writing state was significantly higher than that of the other three conditions(P＜0.05).③ There was no significant difference between the left and right ears in the residual noise level and amplitude of wave V for non-sedated ABR in writing state(P＞0.05).Conclusion Compared with traditional ABR,the non-sedated KWA ABR system in uriting state was significantly higher than that of the other three conolitions.Haw ever,the residual noise level in lying and sit-ting states had no significant difference with conditional ABR,and different states of the subject had impact on the residual noise level in the ABR testing to sone extent.

AIM:This study aims to explore the impact of Escherichia coli(E.coli)high-pathogenicity island(HPI)on pyroptosis and intestinal inflammation.METHODS:Kunming mice and IPEC-J2 cells(porcine small intesti-nal epithelial cells)were treated with HPI-containing E.coli strain(HPI+),HPI-deleting E.coli strain(ΔHPI),or lipo-polysaccharide(LPS).The intestinal lactate dehydrogenase(LDH)activity,superoxide dismutase(SOD)activity,IgA expression and secretory IgA(SIgA)content were assessed in mice.The expression of key regulatory factors in the nucleo-tide-binding oligomerization domain-like receptor protein 3(NLRP3)/caspase-1 signaling pathway-related proteins in mouse intestinal tract and IPEC-J2 cells was analyzed by RT-qPCR,immunohistochemical staining and Western blot.The levels of interleukin-1β(IL-1β)and IL-18 in mouse serum and IPEC-J2 cell culture supernatants were measured by ELISA.The pivotal role of NLRP3 in HPI+infection was confirmed by silencing NLRP3 in IPEC-J2 cells using siRNA.RE-SULTS:The HPI+infection markedly decreased SOD activity,increased IgA+B cell count,and induced the LDH release and SIgA secretion in the mouse intestine compared with ΔHPI infection.The results of ELISA,HE staining and TUNEL staining indicated that E.coli HPI triggered DNA damage,tissue injury and inflammation in mouse intestinal epithelial cells.Western blot revealed an increase in intestinal gasdermin D N-terminal fragment(GSDMD-N)protein level with HPI+infection compared with ΔHPI infection.E.coli HPI significantly up-regulated mRNA and protein expression of NLRP3,apoptosis-associated speck-like protein containing a caspase recruitment domain(ASC),caspase-1,GSDMD,IL-1β and IL-18 in mouse intestinal tissues and IPEC-J2 cells,accompanied by the elevated secretion of IL-1β and IL-18.The confo-cal microscopy demonstrated an enhanced assembly of the NLRP3 inflammasome with HPI+infection compared with ΔHPI infection,leading to colocalization of NLRP3 and caspase-1.Furthermore,NLRP3 silencing in IPEC-J2 cells attenuated E.coli HPI-induced cell inflammation,damage,and NLRP3/caspase-1 signaling pathway activation.CONCLUSION:The presence of HPI enhances the virulence of E.coli and exacerbates intestinal inflammation.Moreover,pyroptosis,regu-lated by the NLRP3/caspase-1 signaling pathway,plays a pivotal role in the intestinal injury induced by E.coli HPI.

Objective To investigate the incidence rate,clinical characteristics,and prognosis of neonatal stroke in Shenzhen,China.Methods Led by Shenzhen Children's Hospital,the Shenzhen Neonatal Data Collaboration Network organized 21 institutions to collect 36 cases of neonatal stroke from January 2020 to December 2022.The incidence,clinical characteristics,treatment,and prognosis of neonatal stroke in Shenzhen were analyzed.Results The incidence rate of neonatal stroke in 21 hospitals from 2020 to 2022 was 1/15 137,1/6 060,and 1/7 704,respectively.Ischemic stroke accounted for 75％(27/36);boys accounted for 64％(23/36).Among the 36 neonates,31(86％)had disease onset within 3 days after birth,and 19(53％)had convulsion as the initial presentation.Cerebral MRI showed that 22 neonates(61％)had left cerebral infarction and 13(36％)had basal ganglia infarction.Magnetic resonance angiography was performed for 12 neonates,among whom 9(75％)had involvement of the middle cerebral artery.Electroencephalography was performed for 29 neonates,with sharp waves in 21 neonates(72％)and seizures in 10 neonates(34％).Symptomatic/supportive treatment varied across different hospitals.Neonatal Behavioral Neurological Assessment was performed for 12 neonates(33％,12/36),with a mean score of(32±4)points.The prognosis of 27 neonates was followed up to around 12 months of age,with 44％(12/27)of the neonates having a good prognosis.Conclusions Ischemic stroke is the main type of neonatal stroke,often with convulsions as the initial presentation,involvement of the middle cerebral artery,sharp waves on electroencephalography,and a relatively low neurodevelopment score.Symptomatic/supportive treatment is the main treatment method,and some neonates tend to have a poor prognosis.