Objective:To explore the early coagulation function changes of penetrating intestinal firearm injury of pig in high-altitude environments.Methods:Twenty healthy long white piglets were selected and divided into the plain group and the high-altitude group using the random number table method, with 10 pigs in each group. Pigs in the plain group were placed in a plain environment at an altitude of 800 meters, while pigs in the high-altitude group were placed in an experimental chamber simulating an altitude of 6 000 meters for 48 hours. Both groups received pistol gunshot to have firearm penetrating wounds to the abdominal intestinal tract and then returned to the plain observation room. At 0, 2, 4, 8, 12 and 24 hours after injury, coagulation in the peripheral blood and fibrinolytic indexes [prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (Fbg), D-dimer (D-D), and fibrinogen degradation product (FDP)], thromboelastogram (TEG) [reaction time (R), clotting time (K), clot formation rate (α), maximum amplitude (MA) and coagulation composite index (CI) ], platelet parameters [platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), and platelet-large cell ratio (P-LCR)] in the two groups were detected separately.Results:The PT values at 0 and 2 hours after injury in the high-altitude group were significantly lower than those in the plain group, while they were significantly higher at 8, 12 and 24 hours than those in the plain group ( P<0.01); there was no significant difference at 4 hours between the two groups ( P>0.05). The APTT values at 0, 2 and 4 hours after injury in the high-altitude group were significantly lower than those in the plain group, while they were significantly higher at 8, 12 and 24 hours after injury than those in the plain group ( P<0.01). The TT values at 0, 2 and 4 hours after the injury in the high-altitude group were significantly lower than those in the plain group, while they were significantly higher at 12 and 24 hours after injury than those in the plain group ( P<0.01); there was no significant difference at 8 hours after injury between the two groups ( P>0.05). The Fbg, D-D and FDP values at 0, 2, 4, 8, 12 and 24 hours after injury were higher in the high-altitude group than those in the plain group ( P<0.01). The R values at 0, 2 and 4 hours after injury in the high-altitude group were significantly lower than those in the plain group, while they were significantly higher at 8, 12 and 24 hours after injury than those in the plain group ( P<0.01). The K values at 0, 2, 4 and 8 hours after injury in the high-altitude group were significantly lower than those in the plain group, while they were significantly higher at 12 and 24 hours after injury than those in the plain group ( P<0.05 or 0.01). The α angles at 0, 2 and 4 hours after injury in the high-altitude group were significantly higher than those in the plain group, while they were significantly lower at 8, 12 and 24 hours after injury than those in the plain group ( P<0.01). The MA values at 0, 2 and 4 hours after the injury in the high-altitude group were significantly higher than those in the plain group, while they were significantly lower at 8, 12 and 24 hours after injury than those in the plain group ( P<0.01). The CI values at 0, 2 and 4 hours after injury in the high-altitude group were significantly higher than those in the plain group, while they were significantly lower at 8, 12 and 24 hours after injury than those in the plain group ( P<0.01). The PLT values at 0, 2, 4 and 8 hours after injury in the high-altitude group were significantly higher than those in the plain group, while they were significantly lower at 12 and 24 hours after injury than those in the plain group ( P<0.05 or 0.01). The MPV values at 0, 2, 4, 8, 12 and 24 hours after injury in the high-altitude group were significantly higher than those in the plain group ( P<0.01). The PDW values at 2, 4, 8, 12 and 24 hours after injury in the high-altitude group were significantly higher than those in the plain group ( P<0.05 or 0.01), while there was no significant difference in PDW at 0 hour after injury between the two groups ( P>0.05). The P-LCR values at 0, 2, 4, 8, 12 and 24 hours after injury in the high-altitude group were all significantly higher than those in the plain group ( P<0.01). Conclusion:Compared with the plain environments, pig intestinal firearm penetrating injury in the high-altitude environments is more prone to early hypercoagulable state accompanied by mild hyperfibrinolysis, and faster to reach a hypocoagulable state accompanied by obvious hyperfibrinolysis.

ObjectiveTo observe the effectiveness and safety of the Chinese herbal medicine Mingshi Granules （明视方颗粒） for low myopia in children with heart yang insufficiency. MethodsA multicentre， prospective， double-blind randomised controlled study was conducted， in which 290 children with low myopia from 8 centres were randomly divided into 145 cases in the treatment group and 145 cases in the control group， and the treatment group was given education， dispensing glasses， and Chinese herbal medicine Mingshi Granules， while the control group was given education， dispensing glasses， and granules placebo. Both Mingshi Granules and placebo granules were taken orally， 1 bag each time， twice daily， 4 weeks of oral intake and 2 weeks of rest as 1 course of treatment， a total of 4 courses of treatment （24 weeks）. Equivalent spherical lenses， best naked-eye distance visual acuity， ocular axis， corneal curvature K1， adjustment amplitude， traditional Chinese medicine （TCM） symptom scores， calculate the amount of progression of equivalent spherical lenses， were observed at the 12th and the 24th week of treatment， at the 36th week and 48th week of follow-up， resectively， the control rate of myopia progression was evaluated at the 24th week， and safety indexes were observed before treatment. ResultsThe amount of progression of equivalent spherical lenses was lower in the treatment group than in the control group at the 48-week follow-up （P＜0.05）. The control rate of myopia progression at 24 weeks after treatment in the treatment group was higher （57.60%， 72/125） than that in the control group （44.63%， 54/121） （P＜0.05）. The best naked-eye distance visual acuity at 36-week follow-up in the treatment group was higher than that in the control group （P＜0.05）. Equivalent spherical lenses were significantly lower in both groups at all observation time points compared with pre-treatment （P＜0.05）， and were higher in the treatment group than in the control group at the 48-week follow-up （P＜0.05）. The ocular axes of both groups were significantly higher at each observation time point after treatment and at follow-up compared with before treatment （P＜0.05）. The amount of eye axis growth in the treatment group was lower than that in the control group at 24 weeks after treatment and at the 48-week follow-up （P＜0.05）. Corneal curvature K1 was significantly lower in the treatment group at the 24th week of treatment compared to pre-treatment （P＜0.05）. The magnitude of adjustment in the treatment group was significantly higher at the 36-week follow-up and at the 48-week follow-up than before treatment （P＜0.05）. The scores of white/dark complexion， white coating thin pulse， fatigue and total TCM symptom scores of children in both groups at the 12th， 24th， 36th and 48th weeks of follow-up were significantly lower than those before treatment （P＜0.05）； the scores of blurred vision at the 24th and 36th weeks of follow-up were significantly lower than those before treatment （P＜0.05）； and the scores of blurred vision in the treatment group at the 48th week of follow-up were signi-ficantly lower than those before treatment （P＜0.05）. In the treatment group， the score of fatigue was higher than that of the control group at the 36-week follow-up， and the score of blurred vision was lower than that of the control group at the 48-week follow-up （P＜0.05）. No adverse reactions or obvious abnormalities of the safety indexes were observed of the two groups during the treatment. ConclusionChinese herbal medicine Mingshi Granules showed the effect of controlling the progression of low myopia， improving the best naked eye distance visual acuity， slowing down the growth of the eye axis， improving some of the TCM symptoms， with good safety.

Objective:To explore the characteristics and typology of self-care behavior among patients with chronic heart failure (CHF), and analyze their influencing factors.Methods:A cross-sectional study was used. A total of 318 patients with CHF who were hospitalized in the Heart Center of Zhongshan Hospital, Fudan University from November 2022 to July 2023 were selected by continuous enrollment method. The General Information Questionnaire, Heart Failure Self-care Index Scale, Brief Illness Perception Questionnaire, Self-efficacy for Managing Chronic Disease 6-item Scale, Perceived Social Support Scale, Atlanta Heart Failure Knowledge Test-V2 and Self-Care Confidence Scale were used to investigate. Latent profile analysis was utilized to delineate the characteristics and subtypes of self-care behaviors in CHF patients and examine the influencing factors.Results:A total of 291 patients were included in this study, including 190 males and 101 females, aged 67 (61, 74) years old. The analysis identified three latent categories of self-care behaviors among CHF patients: 26 cases in high self-care group, 131 cases in moderate self-care with deficiencies in maintenance and symptom perception group, and 134 cases in low self-care group.Ordered multicategorical Logistic regression analysis revealed that age ( OR=1.023, 95% CI 1.001-1.046, P<0.05), self-care confidence ( OR=0.859, 95% CI 0.817-0.904, P<0.01), and social support ( OR=0.966, 95% CI 0.940-0.993, P<0.05) were the factors influencing the potential categories of self-care behavior in CHF patients. Conclusions:The study identifies distinct categorical characteristics of self-care behaviors in patients with CHF. Healthcare professionals can leverage these findings to identify the self-care behavior characteristics and influencing factors for each patient category at an early stage, thereby providing personalized and precise support strategies to help patients enhance self-care behaviors.

Objective This study aims at establishing a teaching catalog and content for breast rare dis-eases and developing the syllabus for the breast rare disease using integrated multimodality of case-/problem-/resource-based learning(CBL+PBL+RBL).Methods By conducting bibliometrics co-occurrence analysis,we collected 6291 articles on breast rare disease published from January,1975 to June,2024.Additionally,we re-trieved the Textbook on Rare Diseases,the Catalog of Chinese Rare Disease,and Second Batch of Rare Dis-ease Catalog and then decided the teaching content.Results From 16,387 keywords,1000(6.1％)keywords were identified through co-occurrence analysis,including 50(0.3％)candidate diseases.These were classified into three categories:rare primary breast diseases,rare genetic mutation-related diseases associated with breast cancer,and rare systemic multi-system diseases involving the breast.From the candidate list,20(0.1％)rare primary breast diseases were further selected for their notable clinical teaching significance,and significant multi-systemic diseases affecting the breast,whether related to gene mutations or not.Teaching plans were draf-ted using a diversified parallel teaching approaches,taking into account the characteristics of different diseases and the focus of different teaching methods.Conclusions This study initiated the development of the teaching content for breast rare diseases and developed the teaching syllabus using the CBL+PBL+RBL integrated multi teaching model and targeting each rare breast disease for the critical point for teaching.

Animals ; Glycyrrhiza/adverse effects* ; Plant Extracts/toxicity* ; Rats ; Rats, Sprague-Dawley ; Sargassum

Objective:To investigate the status of clinical nurses′ professional identity, structural empowerment and psychological empowerment, analyze the correlation between professional identity and structural empowerment and psychological empowerment, and establish a multiple stepwise regression model to discuss the dependence between professional identity and structural empowerment and psychological empowerment in clinical nurses.Methods:A total of 1 008 clinical nurses from Nanjing Drum Tower Hospital, the Affiliated Hospital of Medical School of Nanjing University were selected as the subject by using the convenience sampling method. The General Information Questionnaire, Professional Identity Scale, Conditions of Work Effectiveness Scale, and Psychological Empowerment Scale were used to questionnaire.Results:The professional identity of nurses was at medium level (104.49±19.54), the total scores of structural and psychological empowerment of nurses were 60.09±13.49 and 42.59±7.31. Correlation analysis showed that the total score of professional identity of clinical nurses was positively correlated with the total score of structural empowerment, psychological empowerment and theirs dimensions ( r values were 0.436-0.715, P<0.01). Multivariate stepwise regression results showed that the nurse working years, health status self-assessment, formal empowerment, informal empowerment, work meaning, self-efficacy, work influence was the main influencing factors of nurses professional identity, which explained 60.5% of the total variation. Conclusions:Nursing managers should focus on the professional identity of clinical nurses, by optimizing the management organizational structure and pay attention to the perception of empowerment behavior to improve the comprehensive empowerment level, so as to enhance the professional identity of nurses.

Objective:To explore the incidence and degree of compassion fatigue in clinical nurses, and the effects of psychological empowerment on nurses' compassion fatigue level.Methods:A total of 1 005 clinical nurses were investigated with the general information, Chinese version of Professional Quality of Life Scale, Psychological Empowerment Scale. And the relationship between different degrees of compassion fatigue and psychological empowerment were analyzed by ordinal regression analysis.Results:The incidence of sympathetic fatigue was 93.0%,(935/1 005), mild was 53.8%(541/1 005), medium was 22.7%(228/1 005), severe was 16.5%(166/1 005). The score of Chinese version of Professional Quality of Life Scale three dimensions: compassion satisfaction, burnout, and secondary traumatic stress of clinical nurses were 34.15±5.53, 23.96±5.10, 23.73±5.92. The degree of compassion fatigue was negatively correlated with psychological empowerment score and score of each dimension( r values were 0.094-0.468, all P<0.05). The ordinal regression analysis indicated that job impact(odds ratio(OR) value was 1.095, 95% credible interval( CI) 0.094-0.236, P<0.01), self-efficacy( OR value was 0.920, 95% CI 0.250-0.054 , P<0.01) and job meaning( OR value was 0.820, 95% CI 0.431-0.240, P<0.01) were the independent risk factor of compassion fatigue level. Conclusions:The nurses mainly showed mild compassion fatigue, and main manifestation is secondary traumatic stress. The nurses who had more higher job impact scores were more likely to report higher levels of empathy fatigue, while nurses who had higher job meaning and self-efficacy scores were more likely to have low levels of empathy fatigue. Therefore, it is suggested that nursing managers should carry out timely intervention and management in accordance with the different level of compassion fatigue:improve nurses' perception of work meaning and self-efficacy, and avoid increasing workload while paying attention to the influence of work on perception level.

Objective To explore the multiple mediating role of positive psychological capital and adaptive emotion expression between individual social capital and humanistic care ability in nursing students. Methods From December 2018 to August 2019,the study selected 238 undergraduate nursing students of Grade 2015 to 2018 by cluster stratified sampling as subjects in a medical university. All of students were investigated with the Caring Ability Inventory, Individual Social Capital Questionnaire, Positive Psychological Capital Scale and Emotional Expression Questionnaire in college students of China. Structure equation model was used to analyze the correlations among the variables. Results Among 238 nursing students, the scores of humanistic care ability, individual social capital, positive psychological capital, inhibitory emotion expression, adaptive emotion expression and excessive emotion expression were (185.79±17.52), (20.26±2.38), (125.24±17.71), (17.23±3.86), (20.85±3.91) and (9.70±3.97) respectively. Individual social capital, positive psychological capital, adaptive emotion expression and humanistic care ability had positive correlations with each other (r=0.223-0.627,P<0.01). Multiple mediating effect model analysis showed that the positive psychological capital and adaptive emotion expression had multiple mediating roles between individual social capital and humanistic care ability in nursing students(P<0.05). The relative mediating effects of positive psychological capital, adaptive emotion expression and chain mediation were 83.37％, 11.64 ％ and 4.77％ respectively. Conclusions Nursing students have a low level of humanistic care ability with the adaptive emotion expression. Nursing educators can improve nursing students' individual social capital, enrich their positive psychological capital and strengthen their adaptive emotion expression so as to cultivate the humanistic care ability.

Objective: To understand the status quo and correlation between problem solving ability and positive mental capital of nursing undergraduates. Methods: A total of 238 nursing undergraduate were investigated with the Problem Solving Scale and the Positive Mental Capital Scale. Results: In terms of each dimension in Problem Solving Ability Inventory, the scores from high to low respectively were rational problem solving, positive problem orientation, avoidance style, negative problem orientation, impulsivity/carelessness style, the total score of positive mental capital was 125.24±17.71. Multivariate stepwise regression analysis showed that self-efficacy, hope explained for 29.4% of positive problem orientation variation and 15.4% of explaining rational problem solving variation. Resiliency, self-efficacy explain for 35.8% of the negative problem orientation variation. Hoped, resiliency explained for 9% of impulsive/carelessness style variation and 21.8% of avoidance style variation. Conclusions The problem solving ability of nursing undergraduates was weak, which was closely related to positive psychological capital, and can improve the overall problem solving ability of nursing students by improving their self-efficacy, hope and resiliency.

?? [Abstract]? Objective? To explore the effect of physical cooling method by the use of external cooling ice-packs for treatment of the in-patients with fever. Methods? In accordance with the model of Australian JBI evidence-based health care, the evidence was applied to the clinical practice after evidence generation, and synthesis. Admitted from November 2017 to June 2018 into the hematology department in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, the hyperpyretic patients with blood disease were divided into two groups-observation group and control group randomly. 68 patients were included in each group. The patients in observation group were given by 0.5 g acetaminophen orally along with ice-packs while the patients in control group were just given by 0.5 g oral acetaminophen. The temperature lowering effect in both groups was compared and studied. Results? In the observation group, patients' temperature was (38.90±0.37)℃ before intervention, (38.85±0.36)℃ in 30 minutes after intervention, (38.63±0.52)℃ in 1 hour and (38.07±0.76)℃ in 2 hours. And those for control group were (38.89±0.39),(38.82±0.40),(38.58± 0.59),(37.90±0.67)℃,respectively. Repeated measurement analysis of variance indicated that patients' temperature showed significant differences at each point of time during the study in both group (Ftime=77.862,P＜ 0.01). The intervention methods in the two groups did not interact with different point of time (Finteraction=0.728, P＞0.05). The effect of intervention in different groups at different point of time was not significant (Fgroups=0.909, P＞ 0.05). Conclusions? The use of physical cooling method along with medication is proved to be not significant in the patients' temperature control. Health workers should or not select the physical cooling method based on patients' condition and willingness in order to ensure their vital signs' stability and their comfort.