Objective:To explore the status quo of ICU nurses' core competence in palliative care and analyze its influencing factors.Methods:This is a cross-sectional study. From January to March 2022, totally 148 ICU nurses from two ClassⅢ Grade A hospitals in Zhangjiakou were selected by convenience sampling and investigated with the General Information Questionnaire, Core Competence Questionnaire for Hospice Nurses and Chinese version of Death Attitude Profile-Revised. Pearson correlation analysis and multiple linear regression analysis were used to explore the influencing factors of ICU nurses' core competence in palliative care. A total of 148 questionnaires were distributed in this study, and 143 valid questionnaires were recovered, with an effective recovery rate of 96.62% (143/148) .Results:The total score of palliative care core competence of 143 ICU nurses was (77.28±16.95), and the top 2 dimensions with higher scores on the Chinese version of Death Attitude Profile-Revised were natural acceptance [ (4.40±0.34) points] and escape acceptance [ (3.34±0.49) points]. Pearson correlation analysis showed that palliative care core competency for ICU nurses was negatively correlated with fear of death ( r=-0.214; P<0.05), and positively correlated with both natural acceptance of death and escape from acceptance of death ( r=0.171, 0.221; P<0.05). Multiple linear regression analysis revealed that gender, age, professional title, whether they had participated in palliative care-related training, natural acceptance of death, and escape from acceptance of death were the main influencing factors of the core competence of ICU nurses in palliative care ( P<0.05) . Conclusions:ICU nurses have a high level of core competence in palliative care, and they hold a positive attitude towards death. Nursing managers should pay attention to cultivating ICU nurses' palliative care ability, carry out targeted palliative care training, and vigorously organize death continuing education, guide ICU nurses to establish a positive view of death, and improve their core competence in palliative care.

Background: Patients with dyspepsia are the major group of outpatient department of gastroenterology. Dyspeptic symptoms are closely related to anxiety and/or depression. However, the relationship of anxiety and/or depression to dyspeptic symptoms in outpatients undergoing gastroscopy is still unclear. Aims: To investigate the incidence of anxiety and/or depression in outpatients undergoing gastroscopy and its correlation with the severity of dyspepsia. Methods: Outpatients underwent gastroscopy from November 2021 to December 2021 at West China Hospital, Sichuan University were recruited. Generalized anxiety disorder-7 (GAD-7), patient health questionnaire-9 (PHQ-9) were used to evaluate anxiety and depression, respectively. Rome diagnostic questionnaire for functional gastrointestinal disorders, severity of dyspepsia assessment questionnaire, visceral sensitivity index were used to evaluate dyspepsia. The correlation of anxiety and/or depression with dyspepsia was analyzed. Results: A total of 458 questionnaires were collected effectively, including 146 (31.9%) patients with anxiety and/or depression. Compared with the non-anxiety and depression group, the number of gastroscopy in the anxiety and/or depression group was significantly higher (P<0.05). Compared with the non-anxiety and depression group, the incidences of extremely mild/mild dyspepsia, moderate/severe epigastric fullness, postprandial fullness, epigastric pain and belching were significantly increased in the anxiety and/or depression group (P<0.05). Anxiety and/or depression was significantly correlated with the severity of dyspepsia and visceral sensitivity (r=0.421, r=0.143; P< 0.05). Conclusions: Anxiety and/or depression is common in outpatients undergoing gastroscopy; anxiety and/or depression may lead to repeated endoscopic examinations; anxiety and/or depression is significantly correlated with dyspepsia and visceral sensitivity.

  Objective  To investigate the clinical features of autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy.  Methods  We collected and analyzed the clinical and laboratory data and obtained the clinical characteristics of diagnosis and treatment from fifteen patients with positive GFAP antibody tested by cerebrospinal fluid and diagnosed autoimmune GFAP astrocytopathy by the multi-centers.  Results  The mean age of the first onset of autoimmune GFAP astrocytopathy was 39.73 years old (range 4-65 years), with no significant gender difference. In terms of clinical manifestations, we found the whole brain symptoms including abnormal mental behavior, disturbance of consciousness, epileptic attack accounting for more than 50, , meningitis accounting for 66.7%, myelitis (53.3%), limb tremor (53.3%), vision loss (33.3%); systemic symptoms including fever(100%) and fatigue(86.7%). 46.7% of patients were initially diagnosed with tuberculous meningoencephalitis and were treated with diagnostic antituberculous therapy. The MRI showed 46.7% of patients showed brain linear perivascular radial gadolinium enhancement in the white matter perpendicular to the ventricle.  Conclusions  Autoimmune GFAP astrocytopathy are acute or subacute dieases and the main clinical features include encephalitis, meningitis, myelitis and optic neuritis. They are likely to be misdiagnosed as tuberculous meningoencephalitis and can manifest progressive loss of consciousness in early phase, which is even life threatening.

Objective:To investigate the extent of statistics anxiety and explore its influencing factors among university students majoring in medicine.Methods:The statistics anxiety rating scale (STARS) was first translated into Chinese and modified until the reliability and validity were acceptable. Through online questionnaire, the Chinese version of STARS was used to measure the level of statistics anxiety for students enrolling in the course of Medical Statistics during autumn term 2018 to spring term 2019 in the medical college of a university. The collected data were managed and analyzed by SPSS 25.0.Results:A total of 562 students took part in the survey, and 500 questionnaires were eligible and included in the final analysis. The measurement of Chinese version of STARS showed quite good reliability and validity, with item score of the whole scale being (2.31 ± 0.65) points. The proportions of students with mild, moderate and severe statistics anxiety were 41%, 56% and 3% respectively. Female students had higher extent of anxiety than male students, and undergraduates had higher extent of anxiety than postgraduates. The extent of anxiety of students with different majors from high to low were nursing > (dentistry, basic medicine and pharmacology) > (clinic medicine and public health) respectively. When controlling other factors, the influence of gender, student level and major on statistics anxiety was still statistically significant.Conclusion:Statistics anxiety is prevalent in medical college students. Professional teachers should pay more attention to students' psychological status, conduct targeted counseling to alleviate students' anxiety and help them to improve self-efficacy in statistics learning.

Objective:To retrospectively analyze the impact of adjuvant iodine-125( 125I)brachytherapy on postoperative recurrence and survival for patients with hepatocellular carcinoma (HCC) treated with partial hepatectomy with narrow resection margins. Methods:The data of 72 HCC patients who underwent partial hepatectomy with narrow resection margins from January 2011 to June 2015 at Weihai Municipal Hospital were analyzed retrospectively. The patients were divided into the adjuvant 125I brachytherapy group ( 125I group) ( n=36) and the control group ( n=36). The data of the two groups of patients were compared to study the factors influencing long-term survival outcomes and recurrence. Results:The follow-up time was (45.0±18.4) months. There were no deaths relating to 125I brachytherapy. The median recurrent free survival (RFS) was significantly longer in the 125I group than the control group (41.0 months vs 21.5 months, P<0.05). The 1-, 3- and 5-year RFS rates of the 125I group and the control group were 94.4%, 58.3%, 41.6% versus 86.1%, 33.3%, 25.0%, respectively ( P<0.05). The 1-, 3- and 5-year overall survival (OS) rates of the 125I group versus the control group were 97.2%, 69.4%, 52.8% versus 94.4%, 52.8%, 27.8%, respectively ( P<0.05). On multivariate analysis, 125I implantation was an independent factor affecting RFS and OS ( HR=2.112, 95% CI: 1.155-3.860, P<0.05; HR=2.492, 95% CI: 1.272-4.693, P<0.05). Conclusion:Adjuvant 125I brachytherapy was safe and effective for HCC patients with narrow resection margins after hepatectomy. It obviously reduced the tumor recurrence rate and prolonged the long-term RFS and OS.

Objective: To investigate the effects of free mini-flap on tibial side of third toe on repairing skin and soft tissue defect of finger pulp at the end of finger. Methods: From August 2013 to May 2017, 18 patients with skin and soft tissue defect of finger pulp at the end of finger were admitted to our unit, with 12 men and 6 women aged 16 to 54 years. As the skin and soft tissue defect sites, there were 3 cases of thumb, 8 cases of index finger, 4 cases of middle finger, and 3 cases of ring finger. The area of defects ranged from 2.0 cm×1.4 cm to 3.5 cm×2.4 cm. Free mini-flaps on tibial side of third toes were designed according to area and shape of defects, and the length and width of flaps were 0.1 to 0.2 cm longer than the length and width of the defects, respectively. The area of flaps ranged from 2.1 cm×1.5 cm to 3.7 cm×2.6 cm. The end-to-end anastomosis of subcutaneous veins of flaps and superficial veins of the finger-palm side or superficial dorsal digital vein, the end-to-end tension-free anastomosis of the base metatarsal arteries on tibial side of third toe and proper digital arteries of recipient finger were performed. Besides, anastomosis of base metatarsal nerve on tibial side of third toe and proper digital nerve of recipient finger was performed. The donor sites on feet were sutured directly or repaired with full-thickness skin grafts on medial upper leg of the same side. The survival of flaps after operation and the follow-up of patients were observed. Results: All flaps survived well, with good blood supply. Among the 18 patients, 2 patients lost to follow-up, and 16 patients were followed up for 4 to 36 months. The shape and texture of flaps were good. After reconstruction, finger pulps at the end of finger were plump, with fingerprint. Function of the finger restored well, and the two-point discriminatory distances of flaps were 5 to 10 mm. The donor sites on feet of 14 patients healed after the operation, the other 2 patients had necrosis on edge and central area of skin grafts, and the necrotic area healed after dressing change. The skin graft areas on feet were wear-resistant, with slight damage to donor sites and did not influence shoes wearing and walking. Besides, patients did not feel uncomfortable. Conclusions Skin and soft tissue defects of finger pulp at the end of finger repaired by free mini-flaps on tibial side of third toe are with good shape and slight damage to donor sites, and the operation is simple. It is worthy of popularization and application in clinic.

Objective: To explore the clinical effects of heel lateral flap in repair of skin and soft tissue defects at posterior heel region. Methods: From September 2007 to April 2016, 24 patients (17 males and 7 females, aged 16-70 years) with skin and soft tissue defects at posterior heel region were admitted to our department. The size of skin and soft tissue defects after debridement ranged from 3.0 cm×2.0 cm to 5.0 cm×4.0 cm. The defects were repaired with heel lateral flaps, with size ranging from 3.5 cm×2.5 cm to 6.0 cm×5.0 cm. The flaps were transferred to the donor sites through the loose subcutaneous tunnel. The donor site was repaired by full-thickness skin graft collected from inguinal region. The survival of flaps and the follow-up of patients were observed. Results: All flaps of 24 patients survived successfully. The recipient sites and donor sites were all healed. The patients all had follow-up of 6 to 24 months. At the last follow-up, the flaps were in good shape, with nearly normal color and soft texture. There were 6 cases of grade S3 sensation and 16 cases of grade S3⁺ sensation. The distance of two-point discrimination of flaps ranged from 6 to 11 mm. The lateral foot skin grafts healed well, and the skin of the lateral foot was numb in the range of 4.0 cm×2.0 cm to 9.0 cm×3.0 cm. Conclusions Heel lateral flap can not only repair the skin and soft tissue defects in the posterior region, but also reconstruct the sensory function of the posterior region. It is an ideal method to repair the skin and soft tissue defects in the posterior region.

Objective: To establish a method for the determination of aluminum in blood, and to detect the aluminum content in the blood of occupational aluminum workers. Methods: The morning blood of the aluminum workers was collected in an anticoagulation tube, and the supernatant was centrifuged. The supernatant was diluted with 4% nitric acid containing 1% Triton for 24 h at room temperature, and the supernatant was centrifuged. The supernatant was filtered and the blood aluminum concentration was measured by inductively coupled plasma mass spectrometry and quantified by external standard method. Results: The detection limit of ICP-MS method was 0.39 μg/L, the linear range was 0-160 μg/L, the recoveries were 98.24%-99.65%, and the precision was 0.19%-0.28%. The recoveries of graphite furnace atomic absorption spectrophotometry (GFAAS) were 97.17%-111.18%, and the precision was 0.35%-0.44%. The average blood aluminum concentration of aluminum workers in the normal control group was (19.87±10.65) μg/L. The average blood aluminum concentration of aluminum workers in the expose group was (31.12±11.43) μg/L. Conclusion The method of ICP-MS for the determination of aluminum concentration in blood has a simple pretreatment process, high recovery rate, low detection limit and high precision, which is suitable for popularization.

Objective To investigate the clinical effect of relaying reversed peroneal artery perforator flaps in repairing skin and soft tissue defects at ankle and donor site.Methods A retrospective case series study was conducted on the clinical data of 23 cases of skin and soft tissue defects at ankle and donor site from September 2015 to May 2017.There were 16 males and seven females,with an average age of 35 years (range,18-69 years).The soft tissue defects of ankle ranged from 4.0 cm ×4.0 cm to 11.0 cm × 7.0 cm.The distal perforator flap of the peroneal artery was firstly cut and used to repair the soft tissue defect of the ankle.The proximal perforator flap of the peroneal artery was used to repair the first donor site,and the second donor site was directly sutured at stage Ⅰ.The perforator flap area ranges of the distal and the proximal perforator of the peroneal artery were 6.0 cm ×5.0 cm to 14.0 cm × 8.0 cm and 7.5 cm × 4.0 cm to 14.0 cm × 5.0 cm,respectively.The shape of recipient area and donor area were observed.The clinical effects were evaluated by American Orthopedic Foot and Ankle Association (AOFAS) score and Weber two-point discrimination test.Results All patients were followed up for 6-19 months (mean,12 months).One case had partial necrosis of distal skin of ankle flap after operation and recovered 2 weeks after dressing change.All the other flaps survived smoothly in the first stage.The first donor site had no sunken area or rupture.Some linear scar remained at the second donor site,which did not affect the overall appearance.The flaps were smooth in appearance,good in texture,and close to normal color.The AOFAS score of the foot was 95-98 points,and the distance of two-point discrimination of flaps ranged from 8 to 10 mm.Conclusions The relaying reversed peroneal artery perforator flap has abundant blood supply,and the operation site is located at the lateral crural region,without sacrificing the main artery.It can improve the appearance and function of the first donor area while repairing the soft tissue defect of the ankle.