Objective:To explore the talent cultivation model of nursing professional group under the 1+X certificate system, to build a talent cultivation system for nursing professional groups with "three progressions, four integrations, and five cocultivation"Methods:From 1 July 2021 to 31 December 2023, built a professional group course system of "mutual sharing of foundations, mutual generation of majors, mutual selection of positions, and progressive improvement of abilities". Aligned course content with X certificate content. Deepen the reform of the three education systems, create a "dual teacher" teaching team that combines full-time and part-time work, and build teaching resources that connect the cloud and the ground. The application effect of this model was evaluated in 2021 nursing majors in Cangzhou Medical College by cluster sampling.Results:There were 748 students majoring in nursing in class of 2021, 150 boys aged 19-22(20.00 ± 1.23), 598 girls, aged 19-21(19.00 ± 2.57). There were 118 students majoring in midwifery in class of 2021, all of them were girls, aged 18-20(18.00 ± 2.11). There were 128 students majoring in rehabilitation therapy technology in class of 2021, 66 boys aged 19-21(19.00 ± 2.11), 62 girls aged 19-21(19.00 ± 2.54). Nursing professional group completed the "Basic Nursing Technology Training Guidance", "Elderly Care" and other 5 self-compiled textbooks, 730 students had participated in the X certificate assessment, 729 students e passed the assessment, the passing rate was 99.9%.Conclusions:The talent cultivation model of "three progressions, four integrations, and five co cultivation" in the nursing professional group can cultivate students′ professional abilities, and cultivate a composite technical and skilled talent with multiple abilities and interconnections in one job.

Objective:To analyze the correlation between psychological resilience and stigma, self-efficacy and self-esteem in patients with constipation after lower limb fracture surgery, and to determine nursing counter measures.Methods:A total of 102 patients who underwent lower limb fracture surgery in Jingdezhen Hospital of Traditional Chinese Medicine from April 2020 to March 2023 were convenience sampling selected as the study objects by a cross-sectional survey. They were divided into constipation group and normal group according to whether postoperative constipation was complicated. Baseline data, Psychological Resilience Scale (CD-RISC), Social Impact Scale (SIS), General Self-efficacy Scale (GSES), and Pearson ′s method was used to analyze the correlation between CD-RISC score and SIS score, GSES score, and RSES score in patients with constipation. Results:Totally 102 survey subjects aged 18-75 (38.87 ± 6.83), including 57 males and 45 females. Postoperative constipation occurred in 37 patients, accounting for 36.27% (37/102). The average age, constipation secret history rate, postoperative analgesic use rate, CD-RIS, SIS, GSES and RSES scores of the constipation group were (50.74 ± 5.52) years, 72.97% (27/37), 62.16% (23/37), (42.11 ± 5.03) points, (59.78 ± 6.40) points, (22.74 ± 3.57) points, (20.15 ± 2.32) points, respectively. The normal group was (37.81 ± 7.45) years old, 40.00% (26/65), 41.54% (27/65), (78.43 ± 5.95) points, (36.10 ± 4.03) points, (28.26 ± 3.53) points, (27.05 ± 5.29) points, respectively. The difference between the two groups was statistically significant ( t values were 7.52-31.29, χ2 values were 10.27 and 4.01, all P<0.05). In the constipation group, CD-RISC score was negatively correlated with SIS score, and positively correlated with GSES score and RSES score ( r values were -0.869, 0.608, 0.582, all P<0.05). Conclusions:The incidence of constipation after lower limb fracture is high, and its psychological resilience is related to stigma, self-efficacy and self-esteem. Clinical nursing intervention is needed to improve the prognosis of patients.

In recent years, with the in-depth study of pemphigus, new pathogenesis has been identified based on the desmoglein antibody-mediated immune response mechanism, and new progress has been made in targeted therapy. This review summarizes recent advances in the pathogenesis and targeted therapy of pemphigus.

Objective:To investigate the clinical characteristics and perinatal outcomes of preeclampsia (PE) with severe fetal growth restriction (FGR) as the initial symptom.Methods:This retrospective cohort study included cases of singleton live births with PE and severe FGR delivered at Fujian Maternity and Child Health Hospital from January 2012 to December 2022. The cases were divided into two groups based on the sequence of severe FGR and hypertension onset: the severe FGR-first group and the hypertension-first group. General data, clinical characteristics, pregnancy complications, and neonatal outcomes were analyzed between the two groups. Statistical analyses were performed using t-tests, Mann-Whitney U tests, and Chi-square tests. Multivariate linear regression or logistic regression analyses were used to adjust for the effects of confounding factors on perinatal outcomes. Results:(1) A total of 307 cases were included in the study, with 194 cases (63.2%) in the severe FGR-first group and 113 cases (36.8%) in the hypertension-first group. Compared to the hypertension-first group, the severe FGR-first group had a higher proportion of severe FGR before 32 weeks, later gestational age at PE diagnosis, lower proportion of early-onset PE, greater gestational age at pregnancy termination, and shorter interval from PE diagnosis to pregnancy termination [40.7% (46/113) vs. 59.3% (115/194), χ2=9.87; (32.8±5.1) weeks vs. (35.6±3.4) weeks, t=5.12; 52.2% (59/113) vs. 25.8% (50/194), χ2=21.80; (34.7±3.1) weeks vs. (36.0±3.2) weeks, t=3.43; all P<0.01]. There was no statistically significant difference in the interval between the diagnosis of severe FGR and hypertension between the two groups. (2) Compared to the hypertension-first group, the severe FGR-first group had a lower preterm birth rate and a higher incidence of premature rupture of membranes [69.0% (78/113) vs. 46.9% (91/194), χ2=14.12; 9.7% (11/113) vs. 19.1% (37/194), χ2=4.72; both P<0.05]. After adjusting for differences in gestational age at termination of pregnancy using multivariate logistic regression analysis, the results showed no statistically significant differences in the incidence of pregnancy complications between the two groups. (3) Compared with the hypertension-first group, the severe FGR-first group had higher neonatal birth weight [(1 757±605) g vs. (2 067±684) g, t=4.12], longer birth length [(41.7±4.3) cm vs. (43.4±4.6) cm, t=3.10], and heavier placentas [(399±158) g v s. (486±147) g, t=2.36]. The rates of cesarean section, severe small for gestational age, and low birth weight were lower [85.8% (97/113) vs. 68.6% (133/194), χ2=11.35; 65.5% (74/113) vs. 49.5% (96/194), χ2=7.40; 87.6% (99/113) vs. 69.6% (135/194), χ2=12.80; all P<0.05]. There were no statistically significant differences in the 1-minute Apgar scores and NICU admission rates between the two groups. After adjusting for differences in gestational age at termination of pregnancy using multivariate regression analysis, it was found that compared with the hypertension-first group, the severe FGR-first group had heavier neonates and a lower risk of cesarean section [ OR (95% CI) were 80.18 (0.95-159.42) and 0.51 (0.26-0.99), both P<0.05]. Conclusions:Pregnant women with severe FGR preceding PE have a later onset of PE and relatively better perinatal outcomes compared to those with hypertension preceding PE. It is necessary to strengthen the monitoring of blood pressure fluctuations in pregnant women with severe FGR preceding PE and fetal growth in pregnant women with hypertension preceding PE.

BACKGROUND: The effect of intra-operative chemotherapy (IOC) on the long-term survival of patients with colorectal cancer (CRC) remains unclear. In this study, we evaluated the independent effect of intra-operative infusion of 5-fluorouracil in combination with calcium folinate on the survival of CRC patients following radical resection. METHODS: 1820 patients were recruited, and 1263 received IOC and 557 did not. Clinical and demographic data were collected, including overall survival (OS), clinicopathological features, and treatment strategies. Risk factors for IOC-related deaths were identified using multivariate Cox proportional hazards models. A regression model was developed to analyze the independent effects of IOC. RESULTS: Proportional hazard regression analysis showed that IOC (hazard ratio [HR]=0.53, 95% confidence intervals [CI] [0.43, 0.65], P  < 0.001) was a protective factor for the survival of patients. The mean overall survival time in IOC group was 82.50 (95% CI [80.52, 84.49]) months, and 71.21 (95% CI [67.92, 74.50]) months in non-IOC group. The OS in IOC-treated patients were significantly higher than non-IOC-treated patients ( P  < 0.001, log-rank test). Further analysis revealed that IOC decreased the risk of death in patients with CRC in a non-adjusted model (HR=0.53, 95% CI [0.43, 0.65], P  < 0.001), model 2 (adjusted for age and gender, HR=0.52, 95% CI [0.43, 0.64], P  < 0.001), and model 3 (adjusted for all factors, 95% CI 0.71 [0.55, 0.90], P  = 0.006). The subgroup analysis showed that the HR for the effect of IOC on survival was lower in patients with stage II (HR = 0.46, 95% CI [0.31, 0.67]) or III disease (HR=0.59, 95% CI [0.45, 0.76]), regardless of pre-operative radiotherapy (HR=0.55, 95% CI [0.45, 0.68]) or pre-operative chemotherapy (HR=0.54, 95% CI [0.44, 0.66]). CONCLUSIONS: IOC is an independent factor that influences the survival of CRC patients. It improved the OS of patients with stages II and III CRC after radical surgery. TRIAL REGISTRATION chictr.org.cn, ChiCTR 2100043775.
Humans ; Fluorouracil/therapeutic use* ; Leucovorin/therapeutic use* ; Colorectal Neoplasms/pathology* ; Retrospective Studies ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Proportional Hazards Models ; Prognosis

Objective:To analyze the clinical characteristics of patients with acute glyphosate herbicide poisoning and the differences in the severity of poisoning.Methods:A retrospective analysis was performed on patients with acute glyphosate herbicide poisoning admitted to the First Affiliated Hospital of Zhengzhou University from January 2014 to December 2020. The general information, exposure time, poisoning dose, poisoning cause, poisoning route, clinical manifestations, laboratory examination results during hospitalization, treatment measures, hospital stays and prognosis of the patients were collected. The patients were graded according to the poisoning severity scoring standard of Chinese Expert Consensus on Diagnosis and Treatment of Acute Poisoning in 2016. The highest severity score during hospitalization was used as the final grade. According to the final grade, asymptomatic and mild patients were included in the mild group, and moderate, severe and death patients were included in the severe group. The independent sample T test or Mann-Whitney U test was used for measurement data, and χ2 test or Fisher's exact test was used for counting data. The differences of general data and clinical data between the two groups were compared. Results:According to the inclusion and exclusion criteria, 83 patients with acute glyphosate herbicide poisoning were selected as the study subjects. All patients survived, mainly mild poisoning (56.6%), with a male to female ratio of 33∶50, and an average age of 39 years. The number of poisoning cases increased yearly (the highest in 2019), and most cases occurred in spring and summer. The main cause of poisoning was suicide (71.1%), direct oral administration (83.1%) was the primary route of poisoning, and the dominating clinical manifestations were digestive symptoms (71.1%). Laboratory tests showed increased white blood cell count (WBC), neutrophil percentage (NEUT %) and D-dimer, and decreased hemoglobin and potassium. Compared with the mild group, patients in the severe group were older [(51±17) years vs. (35±19) years], had a higher proportion of suicide and direct oral administration, a longer hospital stay [8.0 (4.8, 12.0) d vs. 3.0 (2.0, 5.5) d], a higher dose of poisoning [200.0 (50.0, 200.0) mL vs. 30.0 (11.3, 57.5) mL], and higher NEUT % within 24 h of admission [(83.4±10.4) vs. (73.2±12.8)]. The increase of WBC, NEUT %, aspartate aminotransferase, prothrombin time, D-dimer and the decrease of serum potassium were more common in the severe group than the mild group, with statistical significance (all P<0.05). Conclusions:The number of patients with acute glyphosate herbicide poisoning is increasing yearly. Generally, the condition is mild and the prognosis is satisfying. The severity is more serious in the middle-aged and elderly patients andthose with direct oral administration, high toxic dose, and high NEUT % within 24 h of admission. Severe poisoning is more likely to cause changes in laboratory indicators.

Objective:To observe the clinical effect of Yiqi Yangjing recipe combined with sticking therapy on lung cancer pleural effusion.Methods:From December 2017 to August 2019, 68 patients with advanced lung cancer and pleural effusion in Pudong New Area Hospital of Traditional Chinese Medicine were selected and randomly divided into two groups by random number table method, with 34 cases in each group.The control group was given furosemide orally on the basis of routine nutritional support treatment, and the treatment group was given Yiqi Yangjing prescription orally and traditional Chinese medicine sticking therapy on the basis of the control group.Both two groups were treated for 6 weeks.The changes of pleural fluid volume and quality of life scores were observed and compared between the two groups.Results:The total effective rate in the treatment group was 70.5%(24/34), which in the control group was 47.1%(16/34), the difference was statistically significant between the two groups(χ 2=3.886, P<0.05). The total effective rate of TCM syndrome integral was 64.7%(22/34) in the treatment group, and 35.3%(12/34) in the control group, the difference was statistically significant between the two groups(χ 2=5.800, P<0.05). After treatment, the overall quality of life score of the treatment group(55.74±5.15)points, which was higher than that of the control group[(51.91±5.20)points]( t=56.130, P<0.05). Conclusion:Yiqi Yangjing recipe combined with traditional Chinese medicine sticking therapy can effectively improve the clinical efficacy of lung cancer hydrothorax, improve the quality of life of patients.

Objective:To investigate the different outcomes of two types of acute kidney injury (AKI) according to standard of Kidney Disease: Improving Global Outcomes-AKI (KDIGO-AKI), and to analyze the risk factors that affect the prognosis of intensive care unit (ICU) patients in China.Methods:A secondary analysis was performed on the database of a previous study conducted by China Critical Care Clinical Trial Group (CCCCTG), which was a multicenter prospective study involving 3 063 patients in 22 tertiary ICUs in 19 provinces and autonomous regions of China. The demographic data, scores reflecting severity of illness, laboratory findings, intervention during ICU stay were extracted. All patients were divided into pure AKI (PAKI) and acute on chronic kidney disease (AoCKD). PAKI was defined as meeting the serum creatinine (SCr) standard of KDIGO-AKI (KDIGO-AKI SCr) and the estimated glomerular filtration rate (eGFR) at baseline was ≥ 60 mL·min -1·1.73 m -2, and AoCKD was defined as meeting the KDIGO-AKI SCr standard and baseline eGFR was 15-59 mL·min -1·1.73 m -2. All-cause mortality in ICU within 28 days was the primary outcome, while the length of ICU stay and renal replacement therapy (RRT) were the secondary outcome. The differences in baseline data and outcomes between the two groups were compared. The cumulative survival rate of ICU within 28 days was analyzed by Kaplan-Meier survival curve, and the risk factors of ICU death within 28 days were screened by Cox multivariate analysis. Results:Of the 3 063 patients, 1 042 were enrolled, 345 with AKI, 697 without AKI. The AKI incidence was 33.11%, while ICU mortality within 28 days of AKI patients was 13.91% (48/345). Compared with PAKI patients ( n = 322), AoCKD patients ( n = 23) were older [years old: 74 (59, 77) vs. 58 (41, 72)] and more critical when entering ICU [acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score: 23 (19, 27) vs. 15 (11, 22)], had worse basic renal function [eGFR (mL·min -1·1.73 m -2): 49 (38, 54) vs. 115 (94, 136)], more basic complications [Charlson comorbidity index (CCI): 3 (2, 4) vs. 0 (0, 1)] and higher SCr during ICU stay [peak SCr for diagnosis of AKI (μmol/L): 412 (280, 515) vs. 176 (124, 340), all P < 0.01]. The mortality and RRT incidence within 28 days in ICU of AoCKD patients were significantly higher than those of PAKI patients [39.13% (9/23) vs. 12.11% (39/322), 26.09% (6/23) vs. 4.04% (13/322), both P < 0.01], while no significant difference was found in the length of ICU stay. Kaplan-Meier survival curve analysis showed that the 28-day cumulative survival rate in ICU in AoCKD patients was significantly lower than PAKI patients (Log-Rank: χ2 = 5.939, P = 0.015). Multivariate Cox regression analysis showed that admission to ICU due to respiratory failure [hazard ratio ( HR) = 4.458, 95% confidence interval (95% CI) was 1.141-17.413, P = 0.032], vasoactive agents treatment in ICU ( HR = 5.181, 95% CI was 2.033-13.199, P = 0.001), and AoCKD ( HR = 5.377, 95% CI was 1.303-22.186, P = 0.020) were independent risk factors for ICU death within 28 days. Conclusion:Further detailed classification (PAKI, AoCKD) based on KDIGO-AKI SCr standard combined with eGFR is related to ICU mortality in critical patients within 28 days.

Objectives:To understand the prevalence of HIV nucleic acid using internet-based dry blood spots HIV testing strategy in men who had sex with men (MSM) and to probe the factors associated with HIV infection.Methods:Using convenient sampling method, 1 375 MSM were recruited and their dry blood spots samples were collected before being mailed to the laboratories for HIV nucleic acid testing. Results were showed to these MSM on a specific website by inputting their codes to it. Non-conditional binary logistic regression method was used to identify the associated factors on HIV infection.Results:The overall proportions of HIV nucleic acid positives appeared as 9.7 % (131/1 349) and HIV antibody positives as 8.3 % (112/1 349). Fresh infections accounted for 14.5 % (19/131) among the newly-identified HIV nucleic acid positives, and the interval was ranging from 6 to 120 days, between the laboratory testings and the closest date that experiencing high risk behavior. Risk factors that related to HIV infection would include: 30 to 39 years of age (comparing to those under the age of 30, OR=1.88, 95 %CI: 1.07-3.29), ≥8 000 Yuan of monthly income (comparing to those without income, OR=0.42, 95 %CI: 0.19-0.96), inconsistent condom use during anal sexual contacts in the last six months (compared with those who had not anal sex or used condoms consistently in anal sex in the past six months, OR=2.22, 95 %CI: 1.45-3.40), ever use of Rush Poppers (compared with those who never used Rush Poppers, OR=2.33, 95 %CI: 1.49-3.64), addictive drug abuse (compared with those who never abused addictive drugs, OR=5.43, 95 %CI: 2.32-12.69), and not having regular sexual partners (compared with having regular sexual partners, OR=1.74, 95 %CI: 1.13-2.68) etc.. Conclusions:Dry blood spots HIV nucleic acid testing could help to identify the fresh HIV infections at an early stage, so as to prevent further transmission in the MSM population, among which fresh HIV infections accounted for a fairly large proportion. It is necessary to set up programs in reducing the abuse of drugs or Rush Poppers, and to promote condom use and advocate on stable sexual partnership etc., among the MSM population.

Objective Bushen-Qingxin decoction combined conjugated estrogen tablets of modulation perimenopausal women osteoporosis patients, explore the impact of bone mineral density and bone metabolic markers. Methods A total of 160 female patients were recruited in our hospital by the random number table method, and were divided into the control group 80 cases and the observation group 80 cases. The control group was treated with standard dose of conjugated estrogen tablets, while the observation group was treated with Bushen Qingxin decoction on the basis of the control group. Both groups were treated 3 period with 28 days per period. The enzyme-linked immunity analyzer was used to detect serum bone-specific alkaline phosphatase (BALP), C-terminal cross linked peptide (CTX-Ⅰ), tartrate resistant acid phosphatase -5b (TRACP-5b) level, and the dual-energy X-ray absorptiometry measurement method was used to detect bone mineral density values. The clinical curative effect was compared between two groups. Results The total effective rate of the observation group was 91.3%, while the control group was 78.8%, which showed the difference was statistically significant (χ 2=3.971, P=3.971). After treatment, the serum BALP levels (88.55 ± 10.33 U/L vs. 80.47 ± 8.67 U/L, t=5.399) of the observation group were significantly higher than this of the control group (P<0.01). After treatment, the serum TRACP-5b (501.31 ± 35.77 pg/L vs. 538.51 ± 37.69 pg/L, t=6.498), CTX- (130.09 ±Ⅰ17.55 ng/ml vs. 164.71 ± 19.45 ng/ml, t=11.928) of the observation group were significantly lower than those of the control group (P<0.01). After treatment, the bone mineral density of the observation group rose up from the baseline (t=3.396, P=0.010). Conclusions The Bushen-Qingxin decoction combined conjugated estrogen tablets can increase on women in the menopausal transition of osteoporosis in patients with bone mineral density values and serum BALP levels, reduce serum TRACP-5b, CTX-Ⅰ level.