Objective To investigate the effectiveness of team-based learning(TBL)combined with research-based learning(RBL)in enhancing evidence-based nursing practice skills of undergraduate nursing interns.Methods A total of 114 undergraduate nursing students who interned in the operating room of a ⅢA hospital in Guangzhou from July 2021 to April 2022 were selected as study subjects.A randomized cluster sampling method based on a random number table was used to divide the students into a control group and a trial group.The control group received traditional teaching methods,while the trial group was taught using a combination of TBL and RBL.The two groups were compared in terms of evidence-based practice skills,critical thinking abilities,and their evaluations on the teaching methods.Results The differences in evidence-based practice skills and critical thinking abilities before and after the internship were significantly higher in the observation group compared to the control group(t=35.108,35.897;both P<0.05).Additionally,post-internship evaluation scores for the teaching methods in the trial group were significantly higher than those in the control group(t=-17.580,P<0.05).Conclusion TBL combined with RBL effectively enhances the evidence-based nursing practice skills and critical thinking abilities of undergraduate nursing interns.This approach also improves students'evaluations on the teaching methods and fosters the cultivation of excellent clinical evidence-based nursing professionals.

Objective:To evaluate the efficacy and safety of Xiao′er Huangjin Zhike Granules in the treatment of cough caused by acute bronchitis in children, which is defined in TCM terms as a syndrome of phlegm-heat obstructing the lung.Methods:This was a block-randomized, double-blind, placebo-controlled, multicenter clinical trial.From January 2022 to September 2023, 359 children aged 3 to 7 years old diagnosed as acute bronchitis (lung-obstructing phlegm-heat syndrome) were enrolled from 21 participating hospitals and randomly assigned to the experimental group and placebo group in a 3︰1 ratio, and respectively treated with Xiao′er Huangjin Zhike Granules and its matching placebo.Cough resolution/general resolution rate after 7 days of treatment was used as the primary efficacy outcome for both groups.Results:(1)On the seventh day of treatment, the rate of cough disappearance/basically disappearance in the experimental group and placebo group were 73.95% and 57.61% retrospectively, which had statistically significance ( P=0.001).(2)After 7 days of treatment, the median duration of cough disappearance/basic disappearance were 5 days and 6 days in the two groups , with a statistically significant difference ( P=0.006).The area under the curve of cough symptom severity time was 7.20 ± 3.79 in the experimental group and 8.20±4.42 in the placebo group.The difference between the two groups was statistically significant ( P=0.039).(3) After 7 days of treatment, the difference between TCM syndrome score and baseline was -16.0 (-20.0, -15.0) points in the experimental group and -15.0 (-18.0, -12.0) points in the placebo group, with significant difference between the two groups ( P=0.004).In the experimental group, the clinical control rate, the markedly effective rate, the effective rate and the ineffective rate were 49.04%, 28.35%, 16.48% and 6.13% severally; and in the placebo group, the clinical control rate, the markedly effective rate, the effective rate and the ineffective rate were 38.04%, 26.09%, 29.35%, and 6.52% separately, which had statistically significant ( P=0.014).(4) There was no significant difference in the incidence of adverse events or adverse reactions during the trial between both groups.Moreover, while adverse reactions in the form of vomiting and diarrhea were occasionally reported, no serious drug-related adverse event or adverse reaction was reported.(5)The tested drug provided good treatment compliance, showing no statistically significant difference from the placebo in terms of compliance rate. Conclusions:Based on the above findings, it can be concluded that Xiao′er Huangjin Zhike Granules provides good safety, efficacy, and treatment compliance in the treatment of cough caused by acute bronchitis, and lung-obstructing phlegm-heat syndrome, in children.

Objective To analyze the influencing factors of treatment compliance in patients undergoing intracranial aneurysm (IA) surgery based on based on latent growth mixture model (LGMM). Methods A total of 150 patients who underwent IA surgery were selected as the study objects. The general data of patients were collected and the compliance scale was used to evaluate the compliance of patients. LGMM was used to predict the change track of treatment compliance of patients with IA after surgery, and the influencing factors of treatment compliance of patients with IA were analyzed by multivariate Logistic regression analysis. Results A total of 138 valid questionnaires were collected in this study, and the effective questionnaire recovery rate was 92.00%. The treatment compliance score of patients with IA was (5.18±1.59) points. After LGMM fitting, 3 potential profiles were selected. There were 37 patients with good compliance (26.81%), 42 patients with moderate compliance (30.43%), and 59 patients with poor compliance (42.75%). The potential profile category attribution probability matrix was 97.29% for patients with good compliance, 95.24% for patients with moderate compliance, and 98.31% for patients with poor compliance. The proportion of poor compliance patients with age of 30 to 50 years old, junior high school education level or below, combined with two or more diseases, out-of-pocket (medical expenses) and Hunt-Hess grade Ⅲ was significantly higher than those with good compliance and moderate compliance (P < 0.05). Age of 30 to 50 years old, Hunt-Hess grade Ⅲ, combined with two or more diseases, education level as junior high school or below and self-expense (medical expenses) were the influential factors of treatment compliance (P < 0.05). Conclusion Treatment compliance of patients undergoing IA surgery is low and heterogeneous. Age of 30 to 50 years old, junior high school education level or below, combination of more than two diseases, medical insurance payment method of self-payment and Hunt-Hess grade Ⅲ are all influencing factors for compliance of IA surgery patients.

Objective:To investigate the relationship between positive asthma prediction index (API) and single nucleotide polymorphisms (SNPs) of interleukin (IL-13), IL-4, β 2 adrenergic receptor (ADRB2), and type I Fc ε receptor β (FcER1B) genes in asthmatic children.Methods:A prospective study was conducted on 102 asthmatic children under 5 years old admitted to Zhongshan Boai Hospital and Foshan First People′s Hospital (51 cases were API positive and 51 cases were API negative) from January 2020 to August 2023. Oral and buccal mucosal exfoliated cells were collected from the children, and genomic DNA was extracted using magnetic bead method. Four gene loci (IL-13 rs20541, IL-4 rs2243250, ADRB2 rs1042713, FcER1B rs569108) were genotyped using a matrix assisted laser desorption ionization time-of-flight mass spectrometer. Logistic regression analysis was used to evaluate the correlation between SNP typing at these four gene loci and API positivity in asthmatic children.Results:There was a statistically significant difference in the SNP typing and allele distribution frequency of IL-13 rs20541, IL-4 rs2243250, ADRB2 rs1042713, FcER1B rs569108 between the API positive and API negative groups of wheezing children (all P<0.05). Among API positive children, the proportion of IL-13 rs20541 site was higher in GG type, the proportion of IL-4 rs2243250 site was higher in TT type, the proportion of ADRB2 rs1042713 site was higher in AG type, and the proportion of FcER1B rs569108 site was higher in AA type; The results of logistic regression analysis showed that IL-13 rs20541 GG type, IL-4 rs2243250 TT type, FcER1B rs569108 AA type were associated with the risk of API positivity in asthmatic children (all P<0.05). Conclusions:IL-13, IL-4, and FcER1B genes are risk genes for the development of API positive wheezing in children under 5 years old. SNP typing of these genes can be used to evaluate the risk of API positivity in clinical practice.

Objective Meta modelling was employed to develop a risk prediction model for intradialytic hypotension(IDH)and validate the model.Methods Literature on risk factors for IDH published up to March 31,2023 was retrieved from 8 databases,including Cochrane Library,PubMed,Web of Science,EBSCO,Scopus,CINAHL,CNKI and Wanfang Database.Random effects model was used to combine ORs,and factors with P＜0.05 were selected to establish the model based on their regression coefficients.286 maintenance hemodialysis patients were selected as a validation cohort to evaluate the model's discrimination,calibration and clinical utility.Results 39 studies were included,involving 25 546 patients.14 factors were identified to establish the risk prediction model.The risk score for IDH occurrence was calculated as-0.301 × male+0.015 × age+0.004 × dialysis vintage+0.988 × diabetes+0.730 × cardiovascular disease-0.042 × predialysis systolic blood pressure+0.666 × dialysis mode of hemodialysis filter+0.076 × temperature+0.159 × ultrafiltration rate+0.476 × ultrafiltration volume+1.024 × weight gain between dialysis+0.053 × serum phosphorus+0.023 × blood urea nitrogen+0.040 ×β2-microglobulin.Definition in the Kidney Disease Outcomes Quality Initiative guideline,nadir intradialytic systolic blood pressure＜90 mmHg(1 mmHg=0.133 kPa),falling intradialytic systolic blood pressure ≥20 mmHg,and definition in the United Kingdom Kidney Association guideline were selected as 4 outcomes.The areas under the curve for the prediction model with respect to these 4 outcomes were 0.830,0.648,0.647,and 0.763,respectively.Calibration curves showed that the model predictive outcomes were consistent with actual outcomes for the first 2 outcomes(x2=14.824,P=0.064;x2=12.016,P=0.149).Decision curve analysis indicated that the model had better net benefit compared to either intervention/no intervention for all definitions.Conclusion The IDH risk prediction model developed by meta-modeling in this study has good predictive performance and certain application value.

Objective:To investigate the application value of the maximum standardized uptake value (SUVmax) of 18F prostate-specific membrane antigen (PSMA) PET/CT combined with the minimum apparent diffusion coefficient (ADCmin) of biparametric magnetic resonance imaging (bpMRI) in predicting pathological upgrading after radical prostatectomy (RP) for prostate cancer. Methods:The data of 89 patients with localized prostate cancer treated at Beijing Hospital from April 2019 to October 2023 were retrospectively analysed. The average age of patients was (68.4±7.0) years old, with prostate-specific antigen (PSA) level of 7.7 (5.4, 12.9) ng/ml, prostate volume of 34.6 (26.9, 47.1) ml, tumor diameter of 1.3 (1.0, 1.8) cm, prostate imaging reporting and data system(PI-RADS) score of 5 in 29 cases (32.6%), clinical stage ≥T 3 in 13 cases (14.6%). There were 31 cases (34.8%) in group 1 of targeted biopsy International Society of Urological Pathology (ISUP)grading groups, 36 cases (40.4%) in group 2, 11 cases (12.4%) in group 3, and 11 cases (12.4%) in group 4. All patients underwent 18F-PSMA PET/CT and bpMRI examinations before RP. The index lesion, identified as the highest Gleason score in pathological whole-mount sections, were outlined. SUVmax and ADCmin values were calculated from the images' region of interest. Pathological upgrading was defined as the post-RP grade group higher than the targeted-biopsy grade group. Clinical data of patients with and without pathological upgrading were compared. Spearman correlation coefficient analysis was used to assess the correlation between SUVmax and ADCmin. Multivariate logistic regression analysis was conducted to evaluate the factors influencing pathological upgrading. Receiver operating characteristic (ROC) curve analysis was employed to assess the predictive value of each indicator for pathological upgrading. Results:Among the 89 cases, 31 cases (34.8%) experienced pathological upgrading. Compared with the patients without pathological upgrading, the SUVmax [11.3 (8.1, 16.4) vs. 6.7 (4.6, 9.2)], SUVmax/ADCmin ratio [3.1 (2.0, 4.6) vs. 1.4 (0.9, 2.1)], PSA [9.8 (6.3, 15.6) ng/ml vs. 7.1 (5.1, 10.5) ng/ml], PSA density [0.3 (0.2, 0.5) ng/ml 2 vs. 0.2 (0.1, 0.3) ng/ml 2], and post-RP ISUP grade group [≥3 group 17 cases (54.8%) vs. 13 cases(22.4%) ]were higher in patients with pathological upgrading, while ADCmin [3.8 (3.0, 5.3) ×10 -4 mm 2/s vs. 5.2 (3.6, 6.1)×10 -4 mm 2/s] and targeted biopsy ISUP grade group [≤2 group 27 cases(87.1%) vs. 40 cases(69.0%) ] were lower (all P<0.05). Spearman analysis showed a negative correlation between SUVmax and ADCmin ( R = -0.227, P = 0.032). Multivariate logistic regression analysis revealed that SUVmax ( OR = 1.108, 95% CI 1.020-1.238), ADCmin ( OR=0.607, 95% CI 0.390-0.874), and SUVmax/ADCmin ratio ( OR = 1.815, 95% CI 1.282-2.949) independently predicted pathological upgrading. The AUC of the SUVmax/ADCmin ratio for predicting pathological upgrading (AUC = 0.817) was higher than that of SUVmax (AUC = 0.774) and ADCmin (AUC=0.686), indicating a higher predictive efficiency. Conclusions:SUVmax, ADCmin, and SUVmax/ADCmin ratio can independently predict pathological upgrading in targeted biopsy of prostate cancer. The SUVmax/ADCmin ratio has a stronger predictive value for pathological upgrading.

Objective To investigate the construction and application of a risk prediction model for deep vein thrombosis (DVT) in patients with aneurysmal subarachnoid hemorrhage (aSAH). Methods A total of 250 patients with aSAH were enrolled in this study and divided into DVT (n=45) and non-DVT groups (n=205) based on the occurrence of DVT. General information and routinelaboratory indicators were collected and compared between the two groups. Multivariate Logistic regression analysis was performed to identify risk factors for DVT in aSAH patients. A nomogram prediction model for DVT after aSAH was established and its discriminative ability was evaluated using the receiver operating characteristic (ROC) curve. The clinical utility of the nomogram was assessed by decision curve analysis. Results Statistically significant differences were observed in age, history of hypertension, Glasgow Coma Scale (GCS) score, Hunt-Hess grade and length of hospital stay between the DVT and non-DVT groups (P < 0.05). The plasma fibrinogen level was significantly higher in the DVT group compared to the non-DVT group (P < 0.05), while no significant differences were found for other indicators (P>0.05). Multivariate Logistic regression analysis revealed that age, Hunt-Hess grade, length of hospital stay, and plasma fibrinogen level were influencing factors of the occurrence of DVT in aSAH patients(P < 0.05). ROC analysis showed that the nomogram exhibited good predictive performance in both the modeling and validation groups, with areas under the curve (AUCs) of 0.875 (95%CI, 0.802 to 0.948) and 0.872 (95%CI, 0.757 to 0.987), respectively. Decision curve analysis indicated that the nomogram provided a high net benefit for predicting DVT in aSAH patients across a wide range of threshold probabilities. Conclusion Age, Hunt-Hess grade, length of hospital stay, and plasma fibrinogen level are influential factors for DVT in aSAH patients. The nomogram in predicting DVT after aSAH demonstrates good discriminative ability, calibration degree, and clinical application value. This model can better identify high-risk patients and provide individualized prevention and treatment strategies.

Humans ; Electronic Health Records ; Phenotype ; Renal Insufficiency, Chronic/epidemiology* ; Databases, Factual ; Algorithms

Objective:To analyze the risk factors for the occurrence of intradialytic hypotension (IDH) in elderly maintenance hemodialysis (MHD) patients based on longitudinal multidimensional data.Methods:This was a single-center, retrospective observational study. Data of MHD patients were retrospectively analyzed from April 3, 2017 to December 31, 2021 in the blood purification center of National Clinical Research Center for Kidney Diseases, General Hospital of Eastern Theater Command. IDH defined by the Kidney Disease Outcomes Quality Initiative was used as outcome indicator. Generalized estimating equations were used for univariate and multivariate regression analysis. The importance of each factor on the occurrence of IDH was evaluated by chi-square statistic minus degrees of freedom, and sensitivity analysis was performed by 5-fold interpolation of missing data.Results:A total of 156 elderly patients were enrolled, 91(58.3%) of whom were male, and 2 681 dialysis data recordings were included. The incidence of IDH from 2017 to 2021 fluctuated from 8.3% to 13.2%, with an average incidence of 11.0% by 2021. The results of multivariate regression showed pre-dialysis systolic pressure of 140-159 mmHg (1 mmHg=0.133 kPa, 90-139 mmHg as reference: OR=0.482, 95% CI 0.273-0.851, P=0.012), pre-dialysis diastolic pressure ≥ 90 mmHg (60-89 mmHg as reference, 90-99 mmHg: OR=4.081, 95% CI 2.132-7.809, P < 0.001; ≥ 100 mmHg: OR=8.547, 95% CI 3.233-22.597, P < 0.001), albumin (34-48 as reference, < 34 g/L: OR=2.677, 95% CI 1.592-4.502, P < 0.001; > 48 g/L: OR=2.692, 95% CI 1.102-6.577, P=0.030), C-reactive protein ≥ 8 mg/L (< 8 mg/L as reference: OR=1.787, 95% CI 1.216-2.628, P=0.003), hemodiafiltration as the dialysis mode (hemodialysis as the reference: OR=2.256, 95% CI 1.395-3.648, P=0.001), actual ultrafiltration volume/dry body mass (per 1% increase, OR=1.539, 95% CI 1.139-2.080, P=0.005), and ultrafiltration rate (per 100 ml/h increase, OR=1.641, 95% CI 1.389-1.939, P < 0.001) were independently associated with the occurrence of IDH. Contribution analysis showed that the top three factors related to IDH were ultrafiltration rate ( χ 2- df=32.798), pre-dialysis diastolic pressure ( χ 2- df=20.757) and albumin ( χ 2- df=19.971). The sensitivity analysis showed that the regression results were robust. Conclusions:The risk factors of IDH in elderly MHD patients are increasing ultrafiltration rate, higher pre-dialysis diastolic pressure(≥ 90 mmHg), lower albumin (< 34 g/L), HDF, higher c-reactive protein(≥ 8 mg/L) and increasing actual ultrafiltration volume/dry body mass. Higher pre-dialysis systolic pressure (140-159 mmHg) is a protective factor.

Objective:To investigate the phylogenetic and antigenic characteristics of hemagglutinin (HA) gene of influenza B/Victoria lineage (BV) viruses in Beijing during the 2021-2022 influenza surveillance season, and to analyze whether the circulating BV viruses match the vaccine strain.Methods:Pharyngeal swab specimens from influenza like-illness (ILI) cases in the 2021-2022 influenza surveillance season were collected from surveillance network labs in Beijing and cultured in MDCK cells and chicken embryo to isolate BV viruses. Nucleic acids of the viruses were extracted, and the HA gene was amplified and sequenced. The nucleotide and amino acid sequence identity of the HA gene was analyzed using MEGA5.0 software. A phylogenetic tree of HA gene was constructed using the maximum likelihood method. The N-glycosylation sites in HA were predicted online. Three-dimensional structure of HA was constructed using SWISS-MODEL homologous modeling. Hemagglutination inhibition (HI) test was performed to analyze the antigenicity of BV viruses.Results:A total of 402 BV viruses were collected and 58 strains with full-length HA gene sequences were chosen for further analysis. Compared with the HA gene of this year′s vaccine strain (B/Washington/02/2019), there were 27 amino acid mutations, 11 of which were located in four different antigenic determinants. The phylogenetic analysis revealed that three subgroups of 1A.3, 1A.3a1, and 1A.3a2 co-circulated in Beijing with 54 strains (54/58, 93.10%) clustered to the Clade 1A.3a2, two strains (2/58, 3.45%) clustered to the Clade 1A.3a1, and two strains (2/58, 3.45%) in the same subgroup (Clade 1A.3) as the vaccine component BV strain in 2021-2022. Compared with the vaccine strain (B/Washington/02/2019), two BV strains had an additional N-glycosylation site at residue 197, while the other 56 strains showed no change in N-glycosylation sites. Antigenic analysis showed that 35 BV strains (35/58, 60.34%) were antigenically similar to the vaccine strain and 23 strains (23/58, 39.66%) were low-response strains.Conclusions:Three subgroups of BV viruses co-circulated in Beijing during the 2021-2022 influenza surveillance season. The predominant subgroup was Clade 1A.3a2 (93.10%), showing a certain genetic distance with the vaccine strain (B/Washington/02/2019). Nearly 40% (39.66%) of the viruses were low-response strains. This study indicated that continuous monitoring of the variations of influenza epidemic strains and timely providing laboratory basis for screening vaccine component strains were the basic technical guarantee for coping with influenza pandemic.