Objective To investigate the changes in blood microbiota in patients with high altitude polycythemia(HAPC)and the correlation with the risk of HAPC.Methods A cross-sectional trial was carried out among 41 HAPC patients(HAPC group)and 41 healthy plateau individuals(control group)who took physical examination in the Health Management Department of No.953 Hospital of PLA Army in 2021.High-throughput sequencing technology was used to detect the V3-V4 variable region of the 16S ribosomal RNA(16S rRNA)gene in the blood smaples,and the composition and difference of the blood microbiota were compared and analyzed between the 2 groups.Results All the participants were male and Han people,and there were no significant differences in baseline data such as age,body mass index and plateau migration time between the 2 groups(P＞0.05).The α-diversity of blood microbiota in the HAPC group,including the Simpson index(0.931±0.005 vs 0.907±0.008,P＜0.05),Goods Coverage index(0.998±0.001 vs 0.997±0.001,P＜0.001)and Pielou index(0.597±0.011 vs 0.567±0.009,P＜0.05)were significantly higher than those in the control group.Meanwhile,obvious difference was observed in the β diversity between the 2 groups(P＜0.01).The relative abundance analysis of bacteria showed that Pelomonas(0.046±0.004 vs 0.033±0.003,P＜0.05),Azospirillum(0.046±0.006 vs 0.021±0.003,P＜0.01),Acidovorax(0.032± 0.003 vs 0.019±0.002,Azospirillum(0.046±0.006 vs 0.021±0.003,P＜0.01)and Acidovorax(0.032± 0.003 vs 0.019±0.002,P＜0.05)were statistically higher in the HAPC group than the control group.LEfSe analysis showed that the characteristic blood microbiota of the HAPC group were α-Proteobacteria,and those of control group were Trichospiridae.Conclusion Significant changes are found in diversity,relative abundance and characteristic bacteria of the blood microbiota between the HAPC patients and healthy people at the high altitude,which might be closely associated with the occurrence and development of HAPC.

High Altitude Military Hygiene is the professional core course of high-altitude medicine, which is significant to the cultivation of military medical talents urgently needed by plateau troops. Under the background of "golden course" construction and army curriculum reform, aiming at the problems such as outdated content of course materials, single teaching mode and insufficient capacity of practical courses, we actively explored the effective path of "golden course" construction, including the renovation of the curriculum-construction concept, the optimization and reorganization of the teaching content, the expansion of case teaching and equipment teaching methods, and the implementation of curriculum ideological and political education and examination reforms. The reform has further improved the learning effect of students and the level of curriculum construction, and also provided beneficial reference for the construction of similar courses in military colleges and universities.

Pulmonary blast injury has become the main type of trauma in modern warfare, characterized by externally mild injuries but internally severe injuries, rapid disease progression, and a high rate of early death. The injury is complicated in clinical practice, often with multiple and compound injuries. Currently, there is a lack of effective protective materials, accurate injury detection instrument and portable monitoring and transportation equipment, standardized clinical treatment guidelines in various medical centers, and evidence-based guidelines at home and abroad, resulting in a high mortality in clinlcal practice. Therefore, the Trauma Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Trauma organized military and civilian experts in related fields such as thoracic surgery and traumatic surgery to jointly develop the Clinical treatment guideline for pulmonary blast injury ( version 2023) by combining evidence for effectiveness and clinical first-line treatment experience. This guideline provided 16 recommended opinions surrounding definition, characteristics, pre-hospital diagnosis and treatment, and in-hospital treatment of pulmonary blast injury, hoping to provide a basis for the clinical treatment in hospitals at different levels.

Humans ; Asthma/drug therapy* ; Biological Therapy

In recent years, the research on the core competence of disaster nursing in China has been relatively active in recent years, but has not yet formed a scale and perfect system. This paper introduces the related concepts of disaster nursing core competence, the development of International Council of Nurses (ICN) disaster nursing core competence framework, summarizes the disaster nursing core competence of different disaster characteristics and rescue groups in China, the evaluation tools of disaster nursing core competence, the cultivation of core competence, and the factors affecting the competence, and puts forward some thoughts and prospects for the construction of disaster nursing core competence in the future.

Objective:To explore the application of reflective circulation fusion link teaching in operating room nursing teaching.Methods:A total of 60 nursing students of operating room accepted by our unit from October 2019 to October 2020 were divided into the control group (30 cases, using routine nursing instruction of operating room) and the experimental group (30 cases, taking reflective circulation fusion link teaching). The assessment results, self-directed learning ability and satisfaction with the teaching before and after the teaching were compared between the two groups. SPSS 26.0 was used for t test and chi-square test. Results:The scores of theoretical knowledge and nursing skills assessment in the two groups were improved, and the scores of the experimental group after teaching were higher than those of the control group[(92.84±5.91) vs. (87.25±7.29); (91.68±7.14) vs. (85.96±8.62)] ( P<0.05); the two groups were both improved in terms of learning awareness, learning behaviors, learning strategies, and learning evaluation and interpersonal skills dimensions, and the scores of the above-mentioned dimensions of the test group after teaching were higher than those of the control group ( P<0.05); the satisfaction scores of improving learning initiative, deepening the understanding and mastery of theoretical knowledge, and enhancing operational skills were higher than those of the control group ( P<0.05). Conclusion:The application of reflective circulation fusion link teaching in nursing students of the operating room can not only enhance the students' assessment results and self-directed learning ability, but also improve their satisfaction of the teaching.

Objective:To explore the effect of fishbone diagram combined with PDCA(plan, do, check, action) closed-loop management in the teaching of orthopedic interns in operating room.Methods:The 60 interns received by the Department of Orthopedics in our hospital from January 2019 to August 2020 were randomly divided into the conventional group and the observation group in average. The conventional group used traditional methods, and the observation group introduced fishbone diagram combined with PDCA closed-loop management. The theoretical and practical assessment scores and the evaluation of satisfaction with the teaching were compared between the two groups before and after the teaching in the operating room. SPSS 22.0 was used for t-test and Chi-square test. Results:The scores of each theoretical assessment, the total scores of theoretical assessments, and the scores of practical assessments, in the observation group were higher than those of the conventional group ( P<0.05). The satisfaction rates of interest, effectiveness, rationality, and popularization with teaching in the observation group were 100.00%, 100.00%, 96.67%, and 100.00% respectively, which were higher than those (80.00%, 83.33%, 80.00%, and 83.33% respectively) in the conventional group. Conclusion:The application of fishbone diagram combined with PDCA closed-loop management in orthopedic operating room teaching can improve the performance of interns in the assessment, and can also achieve better teaching satisfaction.

Objective:To explore the teaching effect of micro class combined with situational exercise for operating room interns.Methods:A total of 42 interns in the operating room of Mianyang Hospital from May 2019 to February 2020 were divided into the control group taking the traditional teaching mode, while 45 interns from March 2020 to December 2020 in the same operating room were divided into the observation group taking the teaching mode of micro class combined with situational exercise. The examination results (theoretical knowledge and practical operation skills) at the time of graduation were compared, and the ability of clinical case analysis and teaching satisfaction were also comparatively analyzed. T-test and chi-square test were performed by SPSS 24.0 software. Results:The scores of theoretical knowledge and practical operation skills in the observation group at the time of graduation were (90.56±4.27) and (93.48±3.59) points respectively, which were higher than those in the control group ( P<0.05). The scores of clinical case analysis ability of the two groups at the time of graduation were higher than those entering the department, and the clinical case analysis ability scores of the observation group [(86.12±6.04) points] were higher than those in the control group [(79.23±5.65) points] at the time of graduation, with statistically significant differences were ( P<0.05). The satisfaction of interns with the improvement of self-study ability and enthusiasm, team cooperation ability, clinical practical operation ability, language expression ability, analyzing and solving problem ability, clinical thinking and knowledge point mastery in the observation group was higher than those in the control group, and the differences were statistically significant ( P<0.05). Conclusion:In the clinical teaching of the operating room interns, the teaching mode of micro class combined with situational exercise can significantly improve the actual teaching effect and enhance the interns' satisfaction to teaching, which has the value of popularization and application.

【Objective】 To explore the viability and advantages of drones in blood emergency delivery. 【Methods】 The delivery of emergency blood by drones to the Second People′s Hospital of Yuhang District(referred as Yuhang Hospital) and the Second Affiliated Hospital of Zhejiang University Medical College (referred as Binjiang Hospital) was analyzed retrospectively. The 8: 00-24: 00 traffic condition, at the interval of 2h, of working days were inquired by Baidu Map in order to compare the driving time with drone flight time. The temperature of RBCs and platelets during drone flight were monitored, and take-off and landing temperature were compared. 【Results】 47 deliveries (a total of 192 bags, 295 U) of suspended RBCs and 35 deliveries (a total of 113 bags, 159.5 therapeutic dose) of platelets were, respectively, conducted to Yuhang Hosital and Binjiang Hospital. Two transfer stations for battery charging were needed during the delivery to Yuhang Hospital, and the average one-way time by driving was similar with by drones(50 vs 55 min), without any superiority in time-efficiency. Binjiang Hospital, however, benefited from this drone delivering(driving 10mins vs drone 6 mins). As round-trip delivery for emergency blood was saved, it’s economical for the hospital to get the time-sensitive blood timely. The temperature of suspended RBCs and platelets during flight was between 2.1~7.9 ℃ and 20.2~24.2 ℃, with temperature difference at 0.3~3.7 ℃ and 0.3~3.6℃, respectively. 【Conclusion】 Drones, with good application prospects, can be applied in emergency blood delivery, and further study is needed to improve the time-efficiency and cold chain monitoring system.

PURPOSE: Details of patients hospitalized for asthma exacerbation in mainland China are lacking. To improve disease control and reduce economic burden, a large sample survey among this patient population is indispensable. This study aimed to investigate the clinical characteristics and outcomes of such patients.METHODS: A retrospective study was conducted on patients hospitalized for asthma exacerbation in 29 hospitals of 29 regions in mainland China during the period 2013 to 2014. Demographic features, pre-admission conditions, exacerbation details, and outcomes were summarized. Risk factors for exacerbation severity were analyzed.RESULTS: There were 3,240 asthmatic patients included in this study (57.7% females, 42.3% males). Only 28.0% used daily controller medications; 1,287 (39.7%) patients were not currently on inhaled corticosteroids. Acute upper airway infection was the most common trigger of exacerbation (42.3%). Patients with severe to life-threatening exacerbation tended to have a longer disease course, a smoking history, and had comorbidities such as hypertension, chronic obstructive pulmonary disease (COPD), and food allergy. The multivariate analysis showed that smoking history, comorbidities of hypertension, COPD, and food allergy were independent risk factors for more severe exacerbation. The number of patients hospitalized for asthma exacerbation varied with seasons, peaking in March and September. Eight patients died during the study period (mortality 0.25%).CONCLUSIONS: Despite enhanced education on asthma self-management in China during recent years, few patients were using daily controller medications before the onset of their exacerbation, indicating that more educational efforts and considerations are needed. The findings of this study may improve our understanding of hospital admission for asthma exacerbation in mainland China and provide evidence for decision-making.
Adrenal Cortex Hormones ; Asthma ; China ; Comorbidity ; Disease Progression ; Education ; Female ; Food Hypersensitivity ; Hospitalization ; Humans ; Hypertension ; Inpatients ; Medication Adherence ; Mortality ; Multivariate Analysis ; Pulmonary Disease, Chronic Obstructive ; Retrospective Studies ; Risk Factors ; Seasons ; Self Care ; Smoke ; Smoking