Objective:To explore the effects of nutritional therapy based on indirect calorimetry in patients with extremely severe burns during hypermetabolic stage.Methods:This study was a retrospective cohort study. From March 25, 2022 to March 30, 2024, 20 extremely severe burn patients who met the inclusion criteria were admitted to the Department of Burn and Wound Repair of the Second Affiliated Hospital of Zhejiang University School of Medicine. There were 15 males and 5 females, aged (46±12) years. The patients were divided into death group (6 cases) and survival group (14 cases) according to their treatment outcomes. At the 3 rd, 7 th, 14 th, and 21 st d after injury, the resting energy expenditure (REE) of patients in the two groups was measured by indirect calorimetry once a day, and the nutritional treatment scheme was formulated according to the results of REE. The REE value, levels of albumin and interleukin-6 (IL-6), actual energy intake, and enteral nutrition energy intake of patients in the two groups at the 3 rd, 7 th, 14 th, and 21 st d after injury were collected (the last two indicators were respectively expressed as the mean values of the 3 rd to 6 th, 7 th to 10 th, 14 th to 17 th, and 21 st to 24 th d after injury). The actual energy intake/REE value and enteral nutrition energy intake/actual energy intake were calculated. Results:The REE values of patients in survival group and death group were (8 143±2 328), (9 843±2 610), (10 149±2 248), (9 608±2 838) kJ and (6 816±2 057), (10 691±2 515), (11 031±2 850), (8 990±2 018) kJ, respectively at the 3 rd , 7 th, 14 th, and 21 st d after injury. The REE value and enteral nutrition energy intake of patients in the two groups showed trends of increase first and decrease then from the 3 rd to 21 st d after injury, while the differences in the above two indicators at each time point between the two groups of patients were not statistically significant ( P>0.05). The actual energy intake of patients in survival group at the 21 st d after injury was significantly higher than that at the 3 rd d after injury ( P<0.05), and the enteral nutrition energy intake of patients in death group at the 14 th d after injury was significantly higher than that at the 3 rd d after injury ( P<0.05). There were no statistically significant differences in overall comparison in actual energy intake/REE value and enteral nutrition energy intake/actual energy intake at each time point after injury between and within the two groups of patients ( P>0.05). The level of IL-6 of patients in survival group at the 21 st d after injury was significantly lower than that at the 3 rd and 7 th d after injury, respectively (with both P values <0.05), and significantly higher than that at the 14 th d after injury ( P<0.05); the level of IL-6 of patients in death group at the 21 st d after injury was significantly higher than that at the 3 rd, 7 th, and 14 th d after injury (with P values all <0.05). The albumin level of patients in survival group at the 7 th d after injury was significantly higher than that at the 3 rd d after injury ( P<0.05). Conclusions:The REE value and enteral nutrition energy intake of extremely severe burn patients showed trends of increase first and decrease then, while they have no significant effects on the clinical outcome of the patients. The nutritional treatment scheme based on the indirect calorimetry can basically meet the energy demand of patients with extremely severe burns during hypermetabolic stage. The impacts of the albumin and IL-6 levels on the clinical outcome of extremely severe burn patients still need further research.

Humanistic caring for patients in the operating room refers to providing the whole process of caring medical services for patients in the operating room. In order to standardize humanistic caring services for patients in the operating room of medical institutions, improve the comprehensive service level of the operating room, and enhance the surgical experience of patients, the Chinese Association for Life Care released the group standard " Humanistic Caring Management Standards for Patients in the Operating Room" in December 2023. This article interpreted the basic requirements for humanistic caring of patients in the operating room, the environment and facilities for humanistic caring, the procedures and measures for humanistic caring, and the quality management framework, aiming to assist administrators and clinical practitioners across various levels of medical institutions in accurately understanding and effectively implementing the standard, and to provide essential textual reference and practical guidance for promoting the application of the standard.

Humanistic caring for patients in the operating room refers to providing the whole process of caring medical services for patients in the operating room. In order to standardize humanistic caring services for patients in the operating room of medical institutions, improve the comprehensive service level of the operating room, and enhance the surgical experience of patients, the Chinese Association for Life Care released the group standard " Humanistic Caring Management Standards for Patients in the Operating Room" in December 2023. This article interpreted the basic requirements for humanistic caring of patients in the operating room, the environment and facilities for humanistic caring, the procedures and measures for humanistic caring, and the quality management framework, aiming to assist administrators and clinical practitioners across various levels of medical institutions in accurately understanding and effectively implementing the standard, and to provide essential textual reference and practical guidance for promoting the application of the standard.

Objective:To explore the effects of nutritional therapy based on indirect calorimetry in patients with extremely severe burns during hypermetabolic stage.Methods:This study was a retrospective cohort study. From March 25, 2022 to March 30, 2024, 20 extremely severe burn patients who met the inclusion criteria were admitted to the Department of Burn and Wound Repair of the Second Affiliated Hospital of Zhejiang University School of Medicine. There were 15 males and 5 females, aged (46±12) years. The patients were divided into death group (6 cases) and survival group (14 cases) according to their treatment outcomes. At the 3 rd, 7 th, 14 th, and 21 st d after injury, the resting energy expenditure (REE) of patients in the two groups was measured by indirect calorimetry once a day, and the nutritional treatment scheme was formulated according to the results of REE. The REE value, levels of albumin and interleukin-6 (IL-6), actual energy intake, and enteral nutrition energy intake of patients in the two groups at the 3 rd, 7 th, 14 th, and 21 st d after injury were collected (the last two indicators were respectively expressed as the mean values of the 3 rd to 6 th, 7 th to 10 th, 14 th to 17 th, and 21 st to 24 th d after injury). The actual energy intake/REE value and enteral nutrition energy intake/actual energy intake were calculated. Results:The REE values of patients in survival group and death group were (8 143±2 328), (9 843±2 610), (10 149±2 248), (9 608±2 838) kJ and (6 816±2 057), (10 691±2 515), (11 031±2 850), (8 990±2 018) kJ, respectively at the 3 rd , 7 th, 14 th, and 21 st d after injury. The REE value and enteral nutrition energy intake of patients in the two groups showed trends of increase first and decrease then from the 3 rd to 21 st d after injury, while the differences in the above two indicators at each time point between the two groups of patients were not statistically significant ( P>0.05). The actual energy intake of patients in survival group at the 21 st d after injury was significantly higher than that at the 3 rd d after injury ( P<0.05), and the enteral nutrition energy intake of patients in death group at the 14 th d after injury was significantly higher than that at the 3 rd d after injury ( P<0.05). There were no statistically significant differences in overall comparison in actual energy intake/REE value and enteral nutrition energy intake/actual energy intake at each time point after injury between and within the two groups of patients ( P>0.05). The level of IL-6 of patients in survival group at the 21 st d after injury was significantly lower than that at the 3 rd and 7 th d after injury, respectively (with both P values <0.05), and significantly higher than that at the 14 th d after injury ( P<0.05); the level of IL-6 of patients in death group at the 21 st d after injury was significantly higher than that at the 3 rd, 7 th, and 14 th d after injury (with P values all <0.05). The albumin level of patients in survival group at the 7 th d after injury was significantly higher than that at the 3 rd d after injury ( P<0.05). Conclusions:The REE value and enteral nutrition energy intake of extremely severe burn patients showed trends of increase first and decrease then, while they have no significant effects on the clinical outcome of the patients. The nutritional treatment scheme based on the indirect calorimetry can basically meet the energy demand of patients with extremely severe burns during hypermetabolic stage. The impacts of the albumin and IL-6 levels on the clinical outcome of extremely severe burn patients still need further research.

Objective To understand the current status and influencing factors of patient perception for humanistic care in China hospitals,and to provide a basis for developing nursing humanistic care measures and improving the quality of nursing humanistic care services.Methods A total of 30,099 outpatients and inpatients from 107 hospitals in 30 provinces(autonomous regions and municipalities)from July to August 2022 as survey subjects.A general information questionnaire and the Relational Caring Questionnaire-Patient Form were used for a cross-sectional survey,and a single-factor analysis was used to analyze the influencing factors of patient relationship care.Results Finally,29 108 valid questionnaires were collected,and the effective questionnaire recovery rate was 96.7％.The patient evaluation of relationship care was(65.72±8.61)points.Single-factor analysis showed that gender,age,marital status,children's situation,education level,occupation,place of residence,average family income,medical insurance type,visiting department,and location of the visiting hospital,and whether or not surgery were influencing factors of patient relationship care(P＜0.05).Conclusion The evaluation score of caregiver-patient relationship care among Chinese hospital patients is above average,but there is still room for improvement in western and rural regions,seriously ill and outpatient patients,low-income and low-medical insurance reimbursement populations,and non-surgical patients.Medical institutions at all levels should optimize and improve nursing humanistic care services based on influencing factors,and further enhance patients'perception of nursing humanistic care.

Objective To investigate the shedding of CAV2-ΔE3-CGS after immunization and the background of canine adenovirus (CAV) infection, and to establish a dual fluorescent quantitative PCR detection method for rabies virus (RV) and canine adenovirus type 2 (CAV2). Methods A dual fluorescent quantitative PCR detection method was established by designing specific primers and probes for E1 gene of CAV and G gene of RV for the detection of CAV2-ΔE3-CGS. Oral swabs, anal swabs and environmental samples of stray dogs from experimental animal farm and dog detention center were tested. Results The standard curves generated by this method were Y=-3.351 × logX + 44.895, R² = .999 and Y=-3.413 × logX + 45.192, R²=0.996, respectively. The linear relationships were good, and the minimum detection limits were both 102 copies/μL. CAV2-ΔE3-CGS was not detected in experimental animal farm. CAV was detected in dog detention center, and the positive rates were 5.88% (5/85) in oral swabs, 8.24% (7/85) in anal swabs, and 4% (1/25) in environmental samples. Conclusion The dual fluorescent quantitative PCR method can be used for the detection of CAV2-ΔE3-CGS after immunization and the investigation of CAV infection. The present study has shown that no CAV2-ΔE3-CGS has been detected after immunization and CAV infection rate of stay dogs is low in Shanghai. CAV2-ΔE3-CGS oral immunization meets requirement and is applicable.

The fatality rate of liver failure caused by fatal amanita poisoning is high, and there are no effective antidote drugs in China. On July 30, 2020, the department of infectious diseases and liver diseases of the First People's Hospital of Yunnan Province admitted a 67-year-old female patient with liver failure caused by fatal amanita poisoning. The patient went to the emergency department for treatment due to abdominal pain, vomiting and diarrhea after eating 350-400 g of amanita mushroom for 2 days, accompanied by fatigue for 1 day. There was no abnormality in physical examination. Laboratory indexes: alanine aminotransferase (ALT) 4 798 U/L, aspartate aminotransferase (AST) 10 030 U/L, activated partial thromboplastin time (APTT) 57.5 s, prothrombin time (PT) 72.1 s, international normalized ratio (INR) 8.66, prothrombinactivity (PA) 10%. Based on the patient's medical history, clinical manifestations and laboratory data, the diagnosis was amanita peptide mushroom poisoning and acute liver failure. According to the mechanism of amanita toxin poisoning as enterohepatic circulation, endoscopic retrograde cholangiopancreatography and ultrasound-guided gallbladder puncture and drainage for drainage of bile to discharge toxins were performed to interrupt the enterohepatic circulation of toxins. However, both methods failed, so open cholecystostomy was performed. Because the patient's coagulation function was very poor, artificial hepatic plasma exchange was given to improve coagulation function before open cholecystostomy, and eventually bile was drained successfully. After a total of 19 days of comprehensive medical treatment, the patient was cured and discharged from the hospital, and no sequelae was found after 1 year of follow-up. For such patients, early identification of the disease is required, and blocking the enterohepatic circulation of toxins as soon as possible according to the characteristics and toxicological mechanism of toxins may be the key treatment for rescuing patients with liver failure poisoned by amanita toxin, and it is necessary to combine comprehensive treatments such as active fluid replacement and blood purification to further improve the survival rate.

Objective:To compare the pros and cons of harvesting ear cartilage through anterior and posterior auricular approaches during rhinoplasty.Methods:From January 2017 to December 2018, 63 patients with otochondral rhinoplasty in our hospital were enrolled in this study, 60 were female and 3 were male; the average age was 31.6 years (range, 18 to 43) . They were randomly divided into anterior auricular approach group with 32 cases (64 sides) and posterior auricular approach group with 31 cases (62 sides). Surgical duration, complications and postoperative scar of the two methods were analyzed.Results:The average time for harvesting the ear cartilage through posterior auricular approach and anterior auricular approach was (20.8±1.7) min and (12.6±1.1) min, respectively ( P<0.01). The overall complication rate was 15.6% for posterior auricular approach group and 4.8% for anterior auricular approach group. The wound healed well in both groups, and there was no significant difference in postoperative scar between the two groups during an average 13 months follow-up period. Conclusions:While both the anterior and the posterior auricular approaches present with similar inconspicuous scarring, the use of anterior auricular approach alone to harvest ear cartilage during rhinoplasty provides both the surgeons and the patients with easier access, shorter surgical duration, and fewer complications. Hence, we believe that the anterior auricular approach possesses greater advantages than the posterior auricular approach.

Objective To analyze the effect of perioperative blood transfusion in orthopedic surgery.Methods A total of 201 patients who underwent an orthopedic surgery in our hospital in October 2015 to September 2016 were reviewed.Hemoglobin concentrations,hematocrit,postoperative hospital stay,infection and other related data were analyzed.Results 90 patients were transfused with blood and in 111 patients were not during orthopedic surgery (massive blood transfusion group including 17 cases;non massive blood transfusion group including 94 cases).Hemoglobin concentrations of transfusion group (103.09±16.37)g/L was lower than the non transfusion group (115.79± 13.68)g/L before liying hospital,postoperative hospitalization time of transfusion group (12.012±8.36) was longer than that of non transfusion group (16.14 ± 10.47)days.Postoperative infection rate in non transfusion group was 1.11％,and in transfusion group was 15.32％,in massive transfusion group is 52.94％.Conclusion Perioperative blood transfusion is not conducive to the recovery of hemoglobin level patients in orthopedic surgery,prolong hospital stay and increase the rate of infection after surgery.Perioperative blood transfusion makes it difficult to support the outcome of the disease

Objective To explore the outpatients′experience of caring and provide references for improving their experience of medical care.Methods The phenomenology research method was adopted in this study,and twenty-one outpatients were subject to an in-depth interview to learn their outpatient experiences.Results Ten themes of experience with caring were extracted as follows:passionate and patient,careful and considerate,respect for others,offers to help,encouraging and comforting,apologies and courteously,humor,truthful considerations,conscientious and responsible,and a caring environment setup.Five themes of experience without caring were extracted as follows:impatient communication, careless seeing of outpatients,delayed service,passive reminders,and facilities without enough details. Conclusions The outpatients may have abundant experiences of caring at the outpatient clinic,also lack of caring sometimes as well.Outpatient managers should keep an eye on outpatients′needs and satisfaction of caring from time to time,to improve the quality of outpatient service.