Objective:To establish a classification system for the repair band in the subchondral bone origination point in MRI for traumatic osteonecrosis of the femoral head (ONFH) and preliminarily explore the correlation between this classification and the progression of femoral head collapse.Methods:A retrospective analysis was conducted on 73 cases of traumatic ON-FH treated at the Quanzhou Orthopedic-traumatological hospital from January 2000 to December 2019. Among them, there were 46 males and 27 females with an average age of 34.9±8.3 years (range 19-55 years). Clinical and radiological data such as age, gender, side, fracture classification, reduction quality, JIC classification, and bone repair band (BRB) classification were recorded. The progression of traumatic ONFH was assessed using the ARCO staging system, with stages IIIA and IIIB defined as mild collapse and progressive collapse, respectively. The BRB classification was established based on MRI findings, and the inter- and intra-observer consistency of the BRB classification was analyzed using Kappa test. The correlation between the BRB classification and progressive femoral head collapse was analyzed using the Kaplan-Meier survival curve and binary variable Cox regression analysis.Results:According to the BRB classification, 73 cases were divided into type 1 with superficial lesion in 38.4%, type 2 with uncertain lesion in 21.9%, and type 3 with extensive lesion in 39.7%. The inter-observer consistency Kappa value for the BRB classification was 0.798, and the intra-observer consistency Kappa value was 0.896, indicating a high level of consistency. A follow-up of 73 cases (54.8±34.9 months, range 24-165 months) showed a significant correlation between the BRB classification and ARCO staging at the last follow-up (χ 2=37.556, P<0.001), with progression to stages IIIA and IIIB as follows: type 1 had 3 and 1 cases, type 2 had 4 and 1 cases, and type 3 had 14 and 12 cases, respectively. Using the occurrence of progressive collapse (stage IIIB) as the endpoint, the risk of progression to stage IIIB for type 2 was not statistically different from type 1 [ HR=1.766, 95% CI (0.465, 6.702), P=0.403]; the risk of progression to stage IIIB for type 3 was significantly higher than for type 1 [ HR=15.126, 95% CI (4.708, 48.592), P<0.001]. Conclusion:The BRB classification is closely related to the progression of traumatic ONFH and is an independent risk factor for predicting the occurrence of progressive collapse; this classification is helpful for early diagnosis and predicting the progression of collapse and treatment plan decision-making.

Objective:To deeply understand the inner experiences of undergraduate nursing interns using Nursing Information Systems (NIS) and provide references for formulating relevant intervention strategies.Methods:A descriptive phenomenological approach was adopted for this qualitative study. Purposeful sampling was used to select undergraduate nursing interns from four comprehensive hospitals in Hangzhou during February to May 2023 for semi-structured interviews. The interview data were analyzed using Colaizzi's seven-step method to extract themes.Results:Four themes were identified in this study: insufficient preparedness of undergraduate nursing interns in using NIS, low engagement of undergraduate nursing interns in using NIS, perceived benefits of using NIS by undergraduate nursing interns, and adaptation strategies of undergraduate nursing interns using NIS.Conclusions:There are issues such as insufficient preparedness and low engagement among undergraduate nursing interns in using NIS. Some respondents experience emotions such as anxiety, fatigue, and decreased enthusiasm. It is recommended that colleges and internship hospitals pay attention to the clinical work demands and the learning needs of nursing interns, thus providing education and support for the use of NIS.

Objective:To explore the research status of artificial intelligence in nursing in China, so as to provide reference for conducting research domestically.Methods:The relevant literature collected from January 1, 2003 to May 1, 2023 was searched on China National Knowledge Infrastructure, WanFang Data, and VIP. CiteSpace and VOS viewer were used to visually analyze the research status, hotspots, and frontiers of artificial intelligence in nursing in China from the aspects of annual publication volume, region, institution, author, high-frequency keywords, and emerging words.Results:A total of 494 articles were included. In terms of publication volume, domestic research showed an overall upward trend, with publishing institutions mostly concentrated in economically developed and medically advanced regions. The authors of the articles often collaborated with research groups, with a co-authorship rate of 81.17% (401/494), but there was relatively little collaboration between groups. Research hotspots were focused on the application of artificial intelligence in geriatric nursing, rehabilitation nursing, Operating Rooms, and drug formulation, with a majority of research related to robots.Conclusions:The research enthusiasm in related fields in China is currently on the rise. Research on artificial intelligence in nursing management, nursing education, and psychological nursing can be strengthened, and the application of artificial intelligence can be enriched. At the same time, research institutions and personnel should strengthen mutual cooperation, and relevant national departments should improve laws and regulations to promote the vigorous development of this research field.

Objective To investigate the therapeutic effect of low-carbohydrate diet and online lifestyle intervention on patients with lean nonalcoholic fatty liver disease(NAFLD).Methods This study was conducted among 53 patients with lean NAFLD who attended Department of Infectious Diseases in Peking University Shenzhen Hospital and Shenzhen Qianhai Shekou Free Trade Zone Hospital from December 2019 to March 2021,and the patients were given low-carbohydrate diet for calorie restriction[total calorie intake was calculated based on basal metabolic rate(BMR)and physical activity level(PAL)and was restricted within(BMR×95%×PAL-1 000)kcal to(BMR×95%×PAL-500)kcal,and carbohydrate ratio fluctuated between 10%and 55%]and lifestyle interventions for 8 weeks.An online software was used for supervision and follow-up,and the patients were observed in terms of treatment outcome and safety.The patients were compared in terms of controlled attenuation parameter(CAP),liver stiffness measurement(LSM),Anthropometric parameters,blood biochemistry,urinary protein,and urine ketone body before and after intervention.The patients were followed up after 1 year to measure body weight and body mass index(BMI).The independent-samples t test was used for comparison of normally distributed continuous data between two groups,and the paired-sample Wilcoxon rank-sum test was used for comparison of non-normally distributed continuous;the chi-square test was used for comparison of categorical data between groups.Results After 8 weeks of intervention,CAP decreased from 304.47±31.91 db/m to 242.43±26.74 db/m,LSM decreased from 7.43±2.41 kPa to 6.36±1.79 kPa,and body weight decreased from 64.29±7.37 kg to 60.24±7.08 kg(t=11.25,3.72,and 14.07,all P<0.001).Of all patients,25(47.2%)had disappearance of fatty liver,and abnormal LSM in 12 patients(63.2%)returned to normal;52 patients(98.1%)had a mean reduction of 4.05±2.32 kg in body weight.The degree of reduction in CAP increased with the degree of reduction in body weight.After intervention,there were significant reductions in BMI,waist circumference,hip circumference,alanine aminotransferase(ALT),aspartate aminotransferase(AST),gamma-glutamyl transpeptidase(GGT),uric acid,fasting blood glucose,triglyceride(TG),total cholesterol(TC),and low-density lipoprotein(LDL)and a significant increase in high-density lipoprotein(t=12.85,13.77,10.28,7.64,6.21,8.35,6.83,6.31,7.4,4.97,5.95,and-2.21,all P<0.05).The patients with abnormal ALT,AST,GGT,uric acid,fasting blood glucose,TG,TC,and LDL at baseline which returned to normal after intervention accounted for 75%,100%,81.8%,57.1%,100%,66.7%,73.5%,and 85.3%,respectively.There were no significant changes in blood urea nitrogen,serum creatinine,urine protein,and urine ketone body(all P>0.05).There was no rebound in body weight and BMI after 1 year of follow-up(P>0.05).There were no gastrointestinal reactions during intervention or follow-up.Conclusion Low-carbohydrate diet and lifestyle intervention can improve liver fat content,liver function,and blood lipid parameters in patients with lean NAFLD,with good safety.

Objective:To explore the job responsibilities, core competencies, and training certification of information nurses in China.Methods:This study is qualitative research. From January to March 2022, purposive sampling was used to select five information nurses and 9 nursing informatics experts from Zhejiang, Jiangsu, Henan, Fujian, and Taiwan in China for semi-structured in-depth interviews. The Colaizzi analysis method was used to analyze data.Results:After interviews, five themes were identified, namely the job responsibilities of information nurses, the need for information nurses to possess multiple core competencies, the need for unified qualification admission for information nurses, the need for systematic and standardized training methods for information nurses, and the need for qualification certification for information nurses.Conclusions:Nursing managers should focus on cultivating the core competencies of information nurses, including professional knowledge and skills, critical thinking, communication and collaboration abilities, specialized expansion abilities, and nursing management abilities, aiming to improve the professional level of information nurses, which is of great significance for the development of nursing informatics.

Objective:To explore the clinical value of T 1 mapping/indexed extracellular volume fraction (iECV) quantified with cardiac MR (CMR) parameters, and its correlation with traditional indicators of myocardial dysfunction in aortic insufficiency (AI) patients. Methods:A total of 36 patients clinically and radiologically diagnosed with chronic AI in our hospital between May 2012 and February 2016 were retrospectively selected. All AI patients underwent conventional CMR protocol, native and post T 1 mapping. CMR parameters, such as aortic regurgitant fraction (RF), late gadolinium enhancement (LGE) mass fraction, myocardial extracellular volume fraction (ECV) and iECV. Based on the values of aortic RF, AI patients were divided into mild AI group (9 cases), moderate AI group (14 cases) and severe AI group (13 cases). The clinical characteristics were teased from the patients′ electronic medical records. Univariate analysis of variance was used to compare the measurement data of native T 1 mapping, post-contrast T 1 mapping, ECV, and iECV. LSD test was used for pair wise comparison between the mild AI, moderate AI and severe AI groups. Data about cardiovascular history, New York Heart Association (NYHA) heart function classification, and LGE were compared by chi-square test or Fisher exact test. The correlation between left ventricle ejection fraction (LVEF) and iECV was evaluated by Spearman correlation analysis. Results:There was no difference in age, sex, cardiovascular history among the three groups. Comparison of patients with different severity of AI in the three groups: (1) There was statistically significant difference in the LGE positive rate among the three groups ( P=0.023), while the myocardial replacement of fibrosis increased with the grade of aortic regurgitation. (2) There was no statistically significant difference in the measurement data of native T 1 mapping, post-contrast T 1 mapping, ECV among the three groups ( H=1.815, 0.929, 2.496, all P values>0.05), while the diffuse myocardial fibrosis tended to increase with the degree of aortic regurgitation. There was statistically significant difference in iECV among the three groups ( H=16.725, P<0.001). The measurement data of iECV in the severe AI group was significantly higher than those in the other two groups ( P<0.05). LVEF value was inversely correlated with iECV ( r=-0.649, P<0.001). Conclusions:Quantitative T 1 mapping/iECV can serve as a parameter to noninvasively identify diffuse myocardial fibrosis in AI patients of different severities. It changes with LVEF and can manifest the reversible stage of left ventricular decompensation.

Unhealthy dietary habits and a sedentary lifestyle have led to a significant increase in the prevalence rate of non-alcoholic fatty liver disease (NAFLD) in children, adolescents, and adults. In recent years, the biological-psychological-social medical pattern has attracted more and more attention, and internal psychosocial factors have become an important influencing factor for disease progression, treatment, and prognosis. Studies have shown that patients with NAFLD may experience psychosocial disorders, and this article summarizes the common psychosocial problems of these patients.

Objective: To investigate the effect and mechanism of polysaccharide of atractylodes macrocephala (PAM) on the growth of colon cancer cells in mice bearing in-situ colon cancer transplantation tumor. Methods: 1×107 colon cancer HT-29 cells labeled with luciferase were injected into colon serosa of the mice to establish the in-situ colon cancer transplantation tumor model. When the tumor volume reached 230 mm3, the mice were given 30 mg/kg PAM (PAM group) or equal volume of normal saline (Control group) by gavage for 10 consecutive days. The effect of PAM on the growth of colon cancer cells in mice was tested by in vivo tumor imaging technology. The expressions of MHCII and IL-12 in granulocytes, dendritic cells and macrophages, the activation of lymphocytes, and IFN-γ expression in CD4+ and CD8+ cells of tumor tissues were detected by Flow cytometry. Results: PAM significantly inhibited the growth of colon cancer cells in mice bearing in-situ colon cancer transplantation tumor (P<0.01). PAM activated immune cells though increasing the expression levels of MHCII and IL-12 in dendritic cells and macrophages (both P<0.01). PAM significantly increased the frequency of CD8+ cells, NK cells, CD44+/NK cells and CD44+/CD4+ cells in tumor tissues and the number of CD8+ cells and NK cells per unit volume (all P<0.01). PAM significantly increased the IFN-γ secretion of CD4+ and CD8+ cells (both P<0.01), too. Conclusion: PAM inhibits the growth of colon cancer by activating immune cells in tumor tissues of mice bearing in-situ colon cancer transplantation tumor.

Objective To explore the imaging characteristics and the complementarity of contrast?enhanced cardiac magnetic resonance CMR and nuclear myocardial perfusion/metabolic imaging in the evaluation of myocardial viability in patients with ischemic cardiomyopathy. Methods A total of 111 patients with diagnosed coronary artery disease and left ventricular dysfunction were retrospectively enrolled in this study. All patients underwent CMR and nuclear myocardial imaging within 1 month. Cine CMR was employed to evaluate cardiac function and wall motion. Contrast?enhanced CMR and myocardial perfusion/metabolic images were quantitatively assessed using a standard 17-segment and 5-score system. Dysfunctional segments were classified as viable or non?viable based on contrast?enhanced CMR and myocardial perfusion/metabolic imaging, respectively. No enhancement or sub?endocardial enhancement was defined as viable, while transmural enhancement was defined as non?viable. Severely matched perfusion/metabolism defects on nuclear imaging were assigned as non?viable while other patterns were considered as viable. Kappa index was calculated to evaluate the diagnostic concordance in assessing myocardial viability between contrast?enhanced CMR and myocardial perfusion/metabolic imaging. Results Among 1 887 segments in 111 patients, 80.3%(1 516/1 887) were dysfunctional. Of them, 63.3%(959/1 516) were viable and 36.7%(557/1 516) were non?viable on contrast?enhanced CMR, while 79.7%(1 208/1 516) were viable and 20.3%(308/1 516) were non?viable on nuclear myocardial imaging. The two modalities had a moderate concordance (Kappa=0.46,P<0.01). In segments with normal perfusion and metabolism, 73.9% (431/583) had various extent of enhancement but most of them(84.2%, 363/431) were subendocardial. On the other hand, 21.0%(117/557) segments with transmural enhancement had hibernating myocardium on nuclear imaging. Conclusions Contrast?enhanced CMR and nuclear myocardial imaging have a moderate concordance in the evaluation of myocardial viability in ischemic cardiomyopathy. Combination of the two modalities is expected to improve the diagnostic accuracy in assessing myocardial viability.

Objective To improve the cleaning quality of reusable medical instruments continuously through root cause analysis,reduce healthcare-associated infection(HAI)and the wear and tear of instruments.Methods The major factors influencing the cleaning quality of instruments were analyzed and clarified by fishbone diagram,contin-uous quality improvement was carried out based on 5 terminal factors,the rate of rusting,stain,repeated cleaning, damage,and clinical department satisfaction before and after the implementation of continuous improvement were compared.Results The qualified rate of instrument clean increased from 94.24% before implementing measures to 97.60% after implementing measures,the rate of rusting,stain,repeated cleaning,damage decreased from 3.39%, 2.37%,5.76%,and 2.08% to 1 .55%,0.85%,2.40%,and 0.48% respectively,there were significant difference among different groups(all P <0.001 );the score of satisfaction rate to central sterile supply department elevated from(93.87±3.87)before implementing measures to (98.08 ±0.59)after implementing measures(t =6.80,P <0.001).Conclusion Root cause analysis is important in improving cleaning quality of reusable instruments continu-ously,as well as reducing HAI and the wear and tear of instrument,it can save medical cost.