Role model education has a profound impact on the attitude and behavioral development of nursing students. This article conducts a search and summary analysis of relevant literature in this field, elaborates on the concept and theoretical basis of role model education, sorts out the characteristics and roles of different types of role models and effective role models in the literature, summarizes the current application status of role model education in the nursing field at home and abroad, and proposes future research directions, aiming to provide reference for the future application of role model education in the nursing field.

Objective:To explore the feasibility of MRI to assist the early diagnosis of midfoot tendon and ligament injuries.Methods:Fifty-two patients with midfoot ligament and tendon injuries who visited Beijing Jishuitan Hospital from September 2016 to December 2021 were enrolled in the study, and 20 healthy volunteers were recruited as controls. All participants underwent mid foot coronal (short axis), sagittal, and axial (long axis) MRI T1 weighted imaging and proton fat suppression sequence examination. The MRI images were evaluated by 2 senior radiologists independently.Results:The consistency of the two radiologists in diagnosis of tendons, ligaments, bones, and soft tissues were good ( κ=0.916, 0.896, and 0.893, respectively). The tendons and ligaments of the midfoot in 20 healthy volunteers (40 feet) showed uniform bands of varying thickness with slightly low signal intensity; the anterior tibial tendon showed a thin line shape, the posterior tibial tendon showed a slightly thick band with uniform low signal intensity, and the calcaneonavicular ligament showed a thin line-like low signal intensity running in different directions. In 52 patients with midfoot tendon and ligament injuries, 18 had anterior tibial tendon injuries, 20 had posterior tibial tendon injuries, and 14 had calcaneonavicular ligament injuries. The injured tendon or ligament was characterized by uneven thickness, blurred edges, and continuous interruption on T1WI sequence, uneven enhancement of signal in the tendon or ligament running area on PD-FS sequence, accumulation of fluid in the tendon sheath, and partial tearing. The partial tear showed discontinuity and thickening of tendons, while the complete tear showed that the tendons were interrupted and retracted, the fiber structure disappeared and was filled with liquid, and the surrounding soft tissue edema was present. Conclusion:MRI can clearly display the course and anatomical structure of the attachment end of the midfoot tendon and ligament, which may assist in early diagnosis of midfoot tendon and ligament injuries.

Immune checkpoint inhibitors(ICIs)have become the most widely used drugs in tumor immunotherapy, with ipilimumab and nivolumab as their representatives.However, the use of immune checkpoint inhibitors has brought about many immune-related adverse events, of which myocarditis is one of the most fatal adverse reactions.The pathogenesis of immune checkpoint inhibitor-associated myocarditis is not fully understood, mainly involving autoimmune T lymphocyte infiltration, regulatory T-cell dysfunction, cytokines, autoantibody production, genetic factors, the gut microbiome, etc.The treatment and management of immune checkpoint inhibitor-associated myocarditis require concerted efforts of multidisciplinary experts.

Objective:To evaluate the application high-resolution 3.0-T magnetic resonance imaging (MRI) in diagnosis of ligament and tendon injuries of the forefeet.Methods:From September 2014 to August 2020, 40 patients with forefeet injury (40 forefoot) and 20 healthy subjects (40 forefoot) meeting the including and excluding criteria were enrolled into this retrospective study. All subjects underwent MRI T1-weighted image (T1WI) and fat suppression proton density-weighted imaging (PD-FS) scan on coronal planes, sagittal planes and axial planes, respectively. Then the MRI characteristics of tendons in forefoot of healthy subjects and patients with forefoot injuries were compared. In patients the MR features of ligament and tendons injury were compared with the surgical findings or follow-up results.Results:In 20 normal subjects the tendons and ligament of the forefoot showed homogeneous low-signal-intensity on T1WI and PD-FS images. In the 40 patients with forefoot injuries, 22 cases were confirmed by surgical findings and 18 cases were confirmed by follow-up results. There were 8 cases of collateral ligament injuries, including 2 cases with complete tear, 3 cases with partial tear and 3 cases with sprain; 2 cases of extensor tendon with partial tear; 8 cases of flexor tendon injuries, including 3 cases with complete tear, 3 cases with partial tear and 2 cases with sprain; 3 cases of abductor tendon with partial tear; 13 cases of plantar plate injuries; and 6 cases of Lisfranc ligament injuries including 5 cases with complete tear and 1 case with partial tear. The injured ligament and tendons presented thicker and discontinuity in T1WI; and demonstrated heterogeneously increased signal intensity with edema in the surrounding soft tissues in PD-FS. The partially torn ligament and tendons showed discontinuity and thickening; and the completely torn ligament and tendons showed that they were interrupted and retracted, fiber structure disappeared and was filled with liquid, and edema in the surrounding soft tissue.Conclusion:High resolution magnetic resonance imaging of the forefoot can demonstrate the anatomy and features of ligament and tendon injuries in forefoot accurately, which has clinical application value for the early diagnosis and accurate treatment of the injury.

Objective:To observe the effect of different temperature rewarming on intraoperative brain protection in children with deep hypothermia circulatory arrest (DHCA).Methods:Totally 24 cases of children undergoing deep hypothermia circulatory arrest under general anesthesia were selected, and randomly divided into 38 ℃ and 43 ℃ groups including 12 cases respectely. Children patients in each group were given forced air rewarming at 38 ℃ and 43 ℃ respectively during the rewarming phase after cross-clamping remission. The age of patients, weight, operation time, intraoperative blood loss, intraoperative fluid infusion and postoperative length of stay were recorded. The arterial blood was taken to determine the serum neuron-specific enolase (NSE) , Platelet activating factor (PAF), and blood lactic acid immediately when the patients were entering into operating room (T 0), before Extracorporeal Circulation (T 1), before aortic cross-clamping (T 2), before DHCA (T 3), rewarming (T 4), temperature to 30 ℃ (T 5), temperature to 33 ℃ (T 6), temperature to 35 ℃ (T 7), CPB was terminated (T 8) and at the end of operation (T 9). And the body temperature were recorded at T 0, T 1, T 3 and T 8. Results:At T 0, T 1, T 3, T 8 and T 9, the temperature difference between the two groups was not statistically significant ( P>0.05). The body temperature first decreased and then increased in the group of 38℃ and 43℃ ( P<0.01). And the serum PAF and NSE significantly increased during the operation ( F values were 5 172.087, 3 535.935, P<0.01). The content of PAF, NSE and lactate in 38 ℃ group and 43 ℃ group increased with time from T 0 to T 9 ( P<0.01).The PAF content of children in the 43℃ group at T 8 and T 9 were (20.34±4.70) μg/L and (25.46±7.75) μg/L respectively, lower than that in the 38℃ group (25.20±3.80) μg/L and (34.97±8.52) μg/L, the differences were statistically significant ( F value was 7.769, P=0.011; F value was 8.193, P=0.009). At T 8 and T 9, NSE content of children in the 43℃ group were (22.13±5.13) μg/L and (28.15±7.90) μg/L respectively, lower than those in the 38℃ group (26.92±3.89) μg/L and (36.57±8.90) μg/L, the differences were statistically significant ( F value was 6.656, P=0.017; F value was 6.012, P=0.023). Blood lactic acid content of children in the 43℃ group at T 4-T 9 respectively (2.77±0.70), (2.93±0.69), (3.13±0.77), (3.39±0.64), (3.77±0.86), (3.83±0.62) mmol/L, lower than 38 ℃ group of children (3.57±0.87), (3.82±0.80), (4.35±0.89), (4.60±0.95), (4.79±0.94), (4.92±0.92) mmol/L, the differences were statistically significant ( F values were 6.125-11.551, P values were 0.022-0.003). Conclusion:Both 38 ℃ and 43 ℃ can ensure that the body temperature of the children increases steadily during the intraoperative rewarming phase in deep hypothermic circulatory arrest operation,but 43℃ can effectively reduce the serum PAF and NSE in children with brain protection, its mechanism may be associated with reduced blood lactic acid.

Objective: To investigate the clinical significance of verticalization of frontal P axis on electrocardiagraphy (ECG) in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) and asthma. Methods: Thirty five COPD patients and 20 asthma patients with acute exacerbation admitted in Jing′an District Central Hospital were enrolled and 20 health subjects served as a control group. The 12 lead ECG examination, pulmonary function test and high resolution CT (HRCT) scan of lung were performed. The P axis in ECG, pulmonary function and CT emphysema score were compared among three groups. The correlation of P axis verticalization with pulmonary function and CT emphysema score was analyzed. Results: There were significant differences in P axis(F=24.36), FEV₁/FVC(F=39.36), FEV₁(F=28.82), FEV₁%(F=30.64), FVC%(F=3.45), PEF%(F=13.22), RV/TLC(F=10.46) and total emphysema score (F=50.60) among the three groups (all P<0.01). P axis was positively correlated with age(r=0.229), total emphysema score(r=0.567), upper lung emphysema score(r=0.542), middle lung emphysema score(r=0.507), lower lung emphysema score(r=0.572)(all P<0.01), and negative correlation with body mass index(r=-0.491), cardiothoracic ratio (r=-0.396), FEV₁/FVC(r=-0.609), FEV₁(r=-0.389), FEV₁%(r=-0.460), and PEF% (r=-0.419)(all P<0.01). Taking P axis>60 ° as cut-off value for screening COPD, the sensitivity was 0.933, specificity was 0.667, positive predictive value was 0.833 and negative predictive value was 0.857. Conclusion The verticalization of frontal P axis on ECG is significantly associated with obstructive ventilation disorder and CT emphysema score, which can be used as a preliminary screening index for COPD.

Unlike adult mammalian heart, zebrafish heart has a remarkable capacity to regenerate after injury. Previous study has shown Notch signaling activation in the endocardium is essential for regeneration of the myocardium and this activation is mediated by hemodynamic alteration after injury, however, the molecular mechanism has not been fully explored. In this study we demonstrated that blood flow change could be perceived and transmitted in a primary cilia dependent manner to control the hemodynamic responsive klf2 gene expression and subsequent activation of Notch signaling in the endocardium. First we showed that both homologues of human gene KLF2 in zebrafish, klf2a and klf2b, could respond to hemodynamic alteration and both were required for Notch signaling activation and heart regeneration. Further experiments indicated that the upregulation of klf2 gene expression was mediated by endocardial primary cilia. Overall, our findings reveal a novel aspect of mechanical shear stress signal in activating Notch pathway and regulating cardiac regeneration.

Objective:To explore the effects of 75% ethanol pre-degreasing combined with 0.5% iodophor disinfection on the number of colonies in the surgical site of brain tumors and the postoperative healing of surgical incisions.Methods:Totally 142 patients who underwent surgery for brain tumors in the Department of Neurosurgery, Qinhuai Medical Area, General Hospital of Eastern Command Theater from January 2017 to December 2018 were selected by convenient sampling, and divided into the control group and the observation group according to the random number table. Patients in the control group received 0.5% iodophor disinfection conventionally, while the surgical site of patients in the observation group was pre-degreased with 75% ethanol prior to 0.5% iodophor disinfection. The number of skin colonies in the surgical site, the continuous exudation time of the incision and the infection of the incision were compared between the two groups.Results:The number of colonies in the observation group was (3.73±0.62) cfu/cm 2 preoperatively and (3.92±0.47) cfu/cm 2 at the end of the operation, both lower than those of the control group, and the differences were statistically significant ( t=2.684, 5.559; P<0.05) . The time of postoperative incision exudation of the observation group was (2.12±0.95) days, which was lower than that of the control group, and the difference was statistically significant ( t=5.415, P<0.05) ; 2 cases of incision infection occurred in the observation group and 9 cases in the control group, and the difference was statistically significant (χ 2=4.834, P<0.05) . Conclusions:In craniotomy for brain tumors, pre-degreasing with 75% ethanol and disinfecting with 0.5% iodophor can reduce the number of colonies in the surgical site, the duration of wound exudation, and the incidence of incision infection.

OBJECTIVE： To establish the fingerprint of Mahai zhitan capsule， to determine the contents of main components， and to provide scientific basis for the stability and quality control of the preparation technology. METHODS： The determination was performed on Inertsil ODS-3 column with acetonitrile-0.1％ phosphoric acid as mobile phase （gradient elution） at the flow rate of 1.0 mL/min. The detection wavelength was set at 250 nm （0-23 min and 31-120 min） and 230 nm （23-31 min）. The column temperature was set at 30 ℃. HPLC fingerprint for 10 batches of Mahai zhitan capsule was established by using “similarity evaluation software for chromatographic fingerprint of traditional chinese medicine” （2012 edition） and the similarity was evaluated. The chromatographic peaks were assigned and identified with reference substance， negative samples without ingredient and substance control respectively， and the identified main components were quantitatively analyzed. RESULTS： The similarity of 10 batches of sample was more than 0.99； 20 common peaks were found， and 10 common peaks were identified. Among them， No. 1，13，14，15，16，17，18，19，20 chromatographic peaks originated from Rheum palmatum； No. 3，4，6，7 chromatographic peaks originated from processed Strychnos nuxvomica； No. 8 chromatographic peaks originated from Angelica sinensis； the corresponding source of medicinal materials was not found in No. 2，5，9，10，11，12 chromatographic peaks. By comparing the reference substances， No. 1，4，6，7，8，16，17，18，19 and 20 chromatographic peaks were identified as gallic acid， loganin acid， strychnine， brucine， ferulic acid， aloe-emodin， rhein， emodin， chrysophanol and emodin methyl ether， respectively. In the determination of identified five main components （loganin， strychnine， brucine， emodin and chrysophanol）， the methodological investigation met the relevant standards. In 10 batches of samples， the contents of loganin， strychnine， brucine， emodin and chrysophanol were 2.477 1-2.785 9， 1.746 1-1.946 0， 1.374 6-1.505 8， 1.573 2-1.824 1 and 0.232 1-0.261 7 mg/g， respectively. CONCLUSIONS： The established method is reliable， accurate， stable and simple， which could provide reference for the preparation technology and quality control of Mahai zhitan capsule.

A review of quality of life(QOL) questionnaires studies in brain injury patients, to help researchers choice reasonable measurement instruments, to provide a reference for the development of the local scale which more in line with China's national conditions and cultures. Universal scales:SIP-68, SF-36, SF-12, WHOQOL–BREF, PedsQL, et al. Specific scales:QOLIBRI, TBI-QOL, EBIQ. The sensitivity of universal scales is poor; Specific quality of life scales are more suitable for assessing the quality of living standards and changes in patients with brain injury.