Objective To characterize the distribution and assess the exposure to phthalic acid esters （PAEs） in the indoor dust of Shanghai City. Methods Samples were collected from 33 sampling sites， including homes， hotels， offices and public places， in Shanghai in 2018， 2019， and 2020. The samples were pretreated by 100 sieves， extracted and concentrated， and then analyzed by gas chromatography-mass spectrometry in selected ion mode （SIM）. Results Results on the characteristics of PAEs in indoor dust in different places showed that concentrations of PAEs were in a range of <0.01-2 464 mg·kg^-1.The average concentration of 16 PAEs was 613 mg·kg^-1. Bis（2-ethylhexyl） phthalate （DEHP）， di-iso-butyl phthalate （DiBP）， di-n-butyl phthalate （DBP） and di-n-octyl phthalate （DnOP） were the main components of PAEs in indoor dust， accounting for approximately 99.5% of 16 PAEs. The intake of DEHP， DBP， DEP and BBP was lower than the tolerable daily intake （TDI） and reference doses （RfD） set by EU CSTEE and U.S. EPA. Conclusion Average daily dose （ADD） via indoor dust is estimated， and the order of intake through different pathways is hand-oral intake>skin contact>respiratory inhalation. Exposure risk of PAEs in children is greater than that in adults.

Group psychological counseling techniques commonly used in nurses' mental health promotion include mindfulness-based group counseling, Balint groups, psychodrama, and the Satir model. Group psychological counseling mainly promotes the mental health of nurses by decreasing nurses' stress, relieving negative emotions, reducing job burnout, enhancing the perceived professional benefit, improving interpersonal relationships and adaptability. This paper reviews the common techniques and application of group psychological counseling, and analyzes the advantages and challenges of group psychological counseling in the promotion of nurses' mental health, with a view to providing a reference for the research and practice of nurses' mental health promotion based on group psychological counseling for researchers.

Group psychological counseling techniques commonly used in nurses' mental health promotion include mindfulness-based group counseling, Balint groups, psychodrama, and the Satir model. Group psychological counseling mainly promotes the mental health of nurses by decreasing nurses' stress, relieving negative emotions, reducing job burnout, enhancing the perceived professional benefit, improving interpersonal relationships and adaptability. This paper reviews the common techniques and application of group psychological counseling, and analyzes the advantages and challenges of group psychological counseling in the promotion of nurses' mental health, with a view to providing a reference for the research and practice of nurses' mental health promotion based on group psychological counseling for researchers.

Objective:To explore the effect of OH cards based group counseling on decompression for chief resident nurses.Methods:In November 2019, a total of 60 chief resident nurses were recruited from two districts of a ClassⅢ Grade A specialized hospital in Shanghai by the convenient sampling method. A total of 58 chief resident nurses participated and completed the questionnaires in the whole process, and they were given OH cards-based decompression group psychological counseling. Before the group psychological counseling, Chinese Version Perceived Stress Scale (CPSS) was used to measure the chief resident nurses' stress. Before and after the group counseling, the Self-made Stress Visual Simulation Score, Self-made Positive and Negative Emotion Visual Simulation Score, State Anxiety Inventory (S-AI) in Chinese version of State-trait Anxiety Inventory (STAI) and Nurses Coping Style Questionnaire were used to evaluate the changes of the chief resident nurses' stress, positive and negative emotion, state anxiety and coping style.Results:Before group psychological counseling, the total CPSS score of 58 chief resident nurses was (30.03±7.10) , which was at a relatively high level. After OH card-based decompression group psychological counseling, the Self-made Stress Visual Simulation Score and the score of negative emotion dimension in S-AI of 58 chief resident nurses were reduced. The Self-made Positive and Negative Emotion Visual Simulation Score and scores of problem solving, avoidance and self-blame, seeking social support and behavior disengagement of Nurses Coping Style Questionnaire were all increased, while the score of alleviating emotional distress dimension was decreased. Compared with those before group psychological counseling, the differences were all statistically significant ( P<0.05) . Conclusions:Group psychological counseling based on OH cards can effectively reduce the pressure of chief resident nurses, reduce negative emotions and state anxiety and improve their coping styles.

Objective:To explore the current situation of empathy for pain in medical students and analyze its influencing factors.Methods:This study was a cross-sectional study. From June 2018 to January 2019, convenience sampling was used to select 768 undergraduate students from 4 medical universities in Shanghai, Jiangsu Province and Zhejiang Province as the research subject. The General Information Questionnaire, the Chinese version of the Empathy for Pain Scale (EPS) , and the Chinese version of the Interpersonal Reactivity Index (IRI-C) were used for investigation. Multiple linear regression was used to analyze the influencing factors.Results:Among 768 medical students, the total score of EPS was (2.56±0.66) , of which the physical and mental discomfort reaction dimension score was (2.28±0.74) , and the empathy reaction dimension score was (3.39±0.79) . The results of multiple linear regression analysis showed that major, being the only child or not, often watching violent movies or not, and personal distress were the influencing factors of medical students' physical and mental discomfort reaction with a statistical difference ( P<0.05) , explaining 20.1% of the variation in total. Gender, grade, clinical learning experience, viewpoint selection, empathic attention and imagination were the influencing factors of the empathy reaction of medical students also with a statistical difference ( P<0.05) , explaining 19.7% of the variation in total. Conclusions:The empathy for pain of medical students is at a moderate level and is affected by many factors. Medical education should strengthen the cultivation of empathy behavior practice ability, and multi-dimensionally cultivate and evaluate students' empathy ability in combination with patients' evaluation.

Objective:To translate the Empathy for Pain Scale (EPS) and evaluate the reliability and validity of the Chinese version of EPS in medical students.Methods:The items of the Chinese version of EPS were determined by translation, back-translation, semantic analysis, expert consultation and culture adaptation. From June to October 2018, this study selected 531 undergraduate students by convenience sampling to carry out questionnaire survey. Correlation analysis and critical ratio were used to the item analysis. Validity test was implemented with the content validity, construct validity and criterion-related validity; and internal consistency was tested with the Cronbach's α value and split-half reliability.Results:The Chinese version of EPS had 12 items and two factors named as the body and mind discomfort reactions and empathy reactions with 69.059% for the total variance contribution. Content validity of items ranged from 0.83 to 1.00, and the total content validity was 0.94. The total score of the Chinese version of EPS had a positive correlation with the score of the interpersonal reactivity index (IRI-C) ( r=0.370, P< 0.01) . The Cronbach's α value of the scale was 0.914; Cronbach's α values of two dimensions, the body and mind discomfort reactions and empathy reactions, were 0.935 and 0.775 respectively. The split-half reliability of the scale was 0.896. Conclusions:The Chinese version of EPS has four scenes and two dimensions as well as a good reliability and validity which could be used to evaluate the level of empathy for pain among medical students in China.

Regardless of the cause of the chest wall defect, especially the extensive chest wall defect, if it cannot be effectively repaired and reconstructed, it may cause physiological and pathological changes such as chest wall softening, respiratory abnormalities and mediastinal oscillations. The main factors affecting the repair and reconstruction of the chest wall are the choice of reconstruction methods and materials. With the increasing understanding of chest wall defects, advances in reconstructive surgery techniques and the development of reconstructed materials, it has become possible to reconstruct many extensive chest wall defects that were previously impossible to complete. This article reviews the characteristics of chest wall defects, methods of repair, and current status and progress of reconstructed materials.

Esophageal cancer (EC) is the eighth dangerous cancer in the world. As the global population ages, the management of elderly patients with EC poses a challenge as they have many aging-associated diseases and physiological changes. In addition, the data on the tolerability of cancer treatment and the use of combined therapies in the patients to guide their treatment are limited. In this paper, we reviewed the literatures and discussed the effect of surgical resection and the potential complications of elderly patients. We reviewed the basic principles of combined therapy and the potential benefits of chemotherapy or chemoradiotherapy for patients and focused on the management of elderly patients with EC as well as the role of comprehensive assessment for aging to provide treatment options for elderly patients.

Thymoma; myasthenia gravis; thoracoscopy combined with mediastinoscopy; thymectomy Objective     To compare the different surgical treatment methods of thymoma combined with myasthenia gravis (MG), and to discuss the clinical effectiveness of thoracoscopic combined mediastinoscopic extended thymectomy. Methods     We retrospectively analyzed the clinical data of 58 patients of thymoma combined with myasthenia gravis in Northern Jiangsu People's Hospital between 2011 and 2016 year. According to the operation method, the patients were divided into three groups including a group A for thoracoscopic thymectomy (n=32), a group B for thoracoscopic combined mediastinoscopic thymectomy (n=15), and a group C for transsternal thymectomy (n=11). The clinical effects were observed and compared. Results     In the group A and the group B, the bleeding volume, postoperative hospital stay and other complications were significantly lower than those in the group C with statistical differences (P<0.05). The incidence of myasthenic crisis in the group B (6.7%) was less than that in the group C (36.4 %), but the difference was not statistically different (P=0.058). The operation time of the three groups was 122.0 ± 39.4 min, 130.3 ± 42.5 min, and 142.3 ± 40.8 min respectively with no statistical difference between the two groups (P>0.05). The rate of dissection grade in the group B (grade 1, 12 patients, 80%) was significantly greater than that in the group A (grade 1, 14 patients, 43.8%, P<0.05). The effective rate of the group A, the group B, the group C was 84.4%, 93.3% and 90.9%, respectively with no statistical difference between groups (P>0.05). Conclusion     The thoracoscopy combined mediastinoscopic thymectomy not only has the advantages of less trauma, quicker recovery and fewer complications, but also can more thoroughly clean the thymus and adipose tissue, which can achieve the same therapeutic effect as the transsternal thymectomy.

Objective To explore the influence of multidimensional social support system on quality of life and psychological state for myasthenia gravis patients underwent VATS.Methods Phenomenological research design and in-depth interviews were conducted for 12 patients with myasthenia gravis in cardiothoracic surgery department in our hospital.And countermeasures were implemented.Results There were four themes drew from MG including the pressure and pains of patients,the difficulties in treatment period and daily life,social support was a great help for patients,adapting and adjusting to MG.Conclusion The quality of life for MG patients is generally lower than healthy people,and the generalized is worse than the ocular after VATS.Increasing the multi-dimensions social support,especially family and peer support is the key factor for the patient's postoperative quality of life.