Objective:To develop and test the reliability and validity of the scale of nurses′ medication competence. To provide scientific basis for the safe medication management of clinical nurses.Methods:Based on the qualitative interview results, combined with role theory and core competence theory, the initial item pool of the scale was formed through literature analysis and discussion in the research group. The first draft of the scale was formed through expert correspondence and pre-investigation. Using the cross-sectional survey methed, from October to November 2022, a questionnaire survey was conducted among 825 clinical nurses from 6 tertiary hospitals in Dalian by convenience sampling method to test the reliability and validity of the scale.Results:Totally 20 experts were consulted, aged 35-49 years old. The nurses′ medication competence evaluation scale contained 11 dimensions, including pharmacological knowledge, medication management ability, medication evaluation ability, medication order checking and execution ability, clinical practice ability, modern technology application ability, educational consulting ability, communication and coordination ability, scientific research and learning ability, ethical and legal practice ability, quality management and risk management ability, with a total of 50 items. Exploratory factor analysis identified 11 common factors, which accounted for 86.525% of the variance. The Cronbach α coefficient of the scale was 0.975, the Cronbach α coefficient of all dimensions were 0.880-0.977, and the retest reliabilities were 0.721-0.875. The content validity index of the scale was 0.99, and the content validity index of all items were 0.83-1.00. The correlation coefficients between the scale and the Competency Inventory for Registered Nurse were 0.636-0.938. Conclusions:The nurses′ medication competence evaluation scale had good reliability and validity, and could be used as an effective tool to evaluate the medication ability of nurses.

As an emerging branch of biology, Synthetic Biology has seen rapid development with great potential in theoretical research and application. With a lot of brand-new concepts and research methods, it brings challenges to university teachers, and little experience is available in China on the teaching of Synthetic Biology. In this study, we discussed the general education-based development and application of the course on Synthetic Biology (a discipline in "liberal arts" in Zhejiang University) from the background, design, implementation, outcome, and problems of the course, hoping to provide a reference for the optimization of the course and the design of similar courses in other universities in China.
China ; Humans ; Synthetic Biology ; Universities

Due to the lack of precise microstructure and functions of the two-dimensional culture model, the in vitro culture models of lung organoids and lung-on-chips, as two main research tools to mimic lung development, homeostasis, injury, and regeneration, allow further exploration of pulmonary fibrosis, lung cancer, and other diseases. Lung organoid refers to isolated lung epithelial stem cells growing in a three-dimensional environment in vitro to form mini-clusters of cells that self-renew, self-reorganize, and differentiate into functional cell types. Based on the microfluidic chip technology, lung-on-chips use porous flexible membrane made of poly to provide tissue-layered structures for cells and simulate microenvironment and mechanical forces. We reviewed the classification, research and development history, establishment methods, practical applications, advantages and disadvantages of two main in vitro culture models derived from lung adult stem cells, hoping to provide a reference for organ transplantation and regeneration and drug screening.
Adult ; Adult Stem Cells ; Humans ; Lung ; Lung Neoplasms ; Organoids ; Stem Cells ; Tumor Microenvironment

Objective:To analyze the causes of postoperative stricture of biliary-enteric anastomotic for congenital choledochal cysts.Methods:These 28 patients underwent salvage operation on an average 15 years (0.2-25 years) after initial surgeries at the Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital from Jan 2014 to Jun 2018.Results:In 26 patients the biliary-enteric anastomotic stenosis was benign, and in 2 the stricture was caused by cancerration. In 26 cases the Roux-en-Y hepaticojejunostomy was redone,among them 8 cases underwent concurrent hepatectomy for a better exposure of the intrahepatic bile duct. In 2 cases the anastomotic stenosis was found to be caused by canceration with extensive intraabdominal metastasis ,an external drainage was adopted. There were no inhospital deaths, and no serious complications. The postoperative follow-up time was 6-67 months. Two cancerated patients died within half a year, and the remaining patients had no long-term complications.Conclusions:Biliary-enteric anastomotic stenosis is one of the serious complications in postoperative patients for congenital choledochal cysts. Hence a wide, tension free biliary-enteric anastomosis performed by a experienced hand is necessary.

Objective:To establish a good model of incomplete ablation of ectopic implanted tumor of liver, and explore the changes in the molecular landscape of residual cancer, cancer in nude mice.Methods:Eight immunodeficient BALB/c nude mice were used to establish an ectopic tumor model with the MHCC97-H hepatoma cell line, and they were randomly divided into experimental group and control group, with 4 mice in each group. The experimental group underwent simulated clinical incomplete ablation, and the control group only underwent false ablation. The differences between the models were evaluated by ultrasonic diagnostic equipment, thermal imaging cameras, HE staining and high-throughput whole transcriptome sequencing.Results:Liver cancer ectopic implantations in nude mices were all successful. The experimental group showed that the temperature of the tumor around the tip of the needle monitored by the thermal imaging camera was at 50-73.9 ℃. Compared with the control group, the HE staining of the experimental group mostly showed the coexistence of necrotic area-degeneration area-tumor cell area. The necrosis area was (23.75±13.77)%, and the degeneration area was 50%(30%). High-throughput whole transcriptome sequencing revealed that there were hundreds of overlapping stable molecular landscapes in the incomplete ablation simulation model both in vivo and in vitro.Conclusions:By establishing an ectopic implantion model of nude mice with incomplete ablation of residual liver cancer, it can provide a basis for studying the biological characteristics of incomplete ablation of residual cancer at the molecular level.

Objective:To understand the levels of selenium and T-2 toxin in the historical critical disease area of Kashin-Beck disease in Aba State of Sichuan Province.Methods:From July 2018 to February 2019, in five cities (counties) of historical critical Kashin-Beck disease areas, namely, Ma'erkang, Rangtang, Aba, Ruo'ergai and Hongyuan, one township was selected, respectively, and then one village in the historical critical disease area and one village in non-disease area were selected from the selected townships. Hair samples from 30 children aged 6 to 12 years old were collected to test selenium content in each village. Staple food samples of 10 households were collected to test the selenium and T-2 toxin contents in each village. Ten soil samples were collected from each village to test the selenium content.Results:The medians selenium of children's hair in the diseased and non-diseased villages ( n= 180, 120) were 0.260 0 and 0.330 0 mg/kg, respectively, and the diseased village was lower than non-diseased village ( Z = - 6.319, P < 0.01). In Ma'erkang and Hongyuan, the medians selenium in the diseased villages were lower than those in non-diseased villages ( Z = - 3.327, - 4.939, P < 0.01), and there were no statistically significant differences between the diseased villages and non-diseased villages in Rangtang and Ruo'ergai ( P > 0.05). The medians selenium of staple food in the diseased and non-diseased villages ( n = 110, 70) were 0.005 8 and 0.018 0 mg/kg, respectively, and the diseased village was lower than non-diseased village ( Z = - 2.263, P < 0.05). In Ruo'ergai, the median selenium in the diseased village was lower than that in non-diseased village ( Z = - 2.306, P < 0.05), and there were no statistically significant differences between the diseased villages and non-diseased villages in Ma'erkang, Rangtang and Hongyuan ( P > 0.05). The T-2 toxin contents in staple food were all less than detection limit (1 μg/kg) in the diseased and non-diseased villages ( n = 103, 65). The soil selenium contents in the diseased and non-diseased villages ( n = 60, 40) were (0.045 3 ± 0.021 5) and (0.065 8 ± 0.045 4) mg/kg, respectively, and the diseased village was lower than non-diseased village ( t = 2.672, P < 0.05). The soil selenium content in the diseased village was lower than that in non-diseased village in Hongyuan ( t = 14.838, P < 0.01). There were no statistically significant differences in the soil selenium content between the diseased villages and non-diseased villages in Ma'erkang, Rangtang and Ruo'ergai ( P > 0.05). Conclusions:The overall selenium level of children's hair is at a medium level (0.25 - < 0.50 mg/kg) in the historical critical disease area of Aba State of Sichuan Province, the selenium levels of staple food and soil are at a deficiency level (< 0.025, < 0.125 mg/kg), and the diseased villages are lower than non-diseased villages. No T-2 toxin is detected in staple food.

Objective: To summarize our clinical experience and management of an anomalous proximal bile duct joining the cystic duct in laparoscopic cholecystectomy (LC). Methods: A retrospective study was conducted on 8 patients who had an anomalous right anterior bile duct joining the cystic duct who were treated at the Hunan Provincial People's Hospital from March 2003 to January 2019. Results: All the 8 patients were diagnosed to have gallstones cholecystitis on preoperative CT, MRI and abdominal ultrasound. There were no suggestions of an anomalous bile duct. A total of 6 patients underwent reoperation after LC due to abdominal pain and biliary peritonitis. These 6 patients were treated with drainage and T-tube insertion. In the other 2 patients, the anomalous bile duct opening which joined the cystic duct were detected during LC. There was one patient converted to open laparotomy with preservation of the cystic duct and underwent common bile duct T-tube drainage. The other patients continued with laparoscopic surgery. The cystic duct was partially resected with removal of gallbladder, followed by common bile duct drainage. The average follow-up period was 3.4 years and the results were satisfactory. Conclusions Biliary duct anomaly is the main cause of iatrogenic proximal bile duct injury during laparoscopic cholecystectomy. It is not uncommon to have the anomaly of insertion of right anterior segmental bile duct to the cystic duct. To avoid iatrogenic biliary tract injury, careful preoperative study of X-ray films, accurate identification of the intraoperative gallbladder triangle anatomical structures. Strict adherence to carry out the three-word procedure of " discrimination, cut, identify" will help to reduce the incidence of biliary tract complications in laparoscopic cholecystectomy.

Objective To explore the treatment experience and efficacy of precise surgery for hepatic caudate lobe involved lesions.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 127 patients with hepatic caudate lobe involved lesions who were admitted to Hunan Provincial People's Hospital between January 2012 and December 2016 were collected,including 71 of malignant tumors,52 of benign lesions and 4 of other diseases.Anatomical hepatectomy was performed in patients via left approach,right approach,anterior approach,left combined with right approach,left and right combined with anterior approach,left and right combined with para-liver hanging tape approach,anterior combined with left approach,retrograde approach according to their conditions.Observation indicators:(1) intraoperative and postoperative recovery situations;(2) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was done to detect postoperative survival of patients up to February 2018.Measurement data with normal distribution were represented as (x)±s.Measurement data with skewed distribution were described as M (range).Kaplain-Meier method was used to calculate survival rate.Results (1) Intraoperative and postoperative recovery situations:all the 127 patients underwent successful operation without perioperative death,including 111 of open surgery and 16 of laparoscopic surgery.Of 127 patients,single total caudate lobectomy and partial caudate lobectomy were performed in 2 and 13 patients,single hepatic segmentectomy combined with total caudate lobectomy,double hepatic segmentectomy combined with total caudate lobectomy,hepatic trisegmentectomy combined with total caudate lobectomy,left hemitectomy combined with total caudate lobectomy,left hepatic trilobectomy combined with total caudate lobectomy,right hemitectomy combined with total caudate lobectomy,right hepatic trilobectomy combined with total caudate lobectomy were performed in 6,4,5,1,1,30,3 patients respectively,single hepatic segmentectomy combined with partial caudate lobectomy,double hepatic segmentectomy combined with partial caudate lobectomy,left hemitectomy combined with partial caudate lobectomy,left hepatic trilobectomy combined with partial caudate lobectomy,right hemitectomy combined with partial caudate lobectomy,right hepatic trilobectomy combined with partial caudate lobectomy were performed in 3,3,41,2,5,8 patients respectively,including 78 via left approach,29 via right approach,2 via anterior approach,7 via left combined with right approach,2 via left and right combined with anterior approach,6 via left and right combined with para-liver hanging tape approach,1 via anterior combined with left approach,2 via retrograde approach.The operation time,time of first hepatic hilum occlusion,volume of intraoperative blood loss and duration of postoperative hospital stay were 285 minutes (range,188-670 minutes),47 minutes(range,30-150 minutes),294 mL(range,20-2 500 mL) and 10 days (range,6-27 days) respectively.Thirty-four patients had postoperative complications,including 21 with abdominal ascites,20 with pleural effusion,6 with incisional infection,5 with hemorrhage,4 with bile leakage,2 with pulmonary infection (1 patient combined with multiple complications).One patient underwent reoperation after ineffective conservative treatment for hemorrhage within postoperative 24 hours and other 33 were cured by conservative treatment.(2) Follow-up and survival situations:of 127 patients,124 including 68 of malignant tumors and 56 of non-malignant tumors were followed up for 2-71 months with a median time of 33 months.During the follow-up,1-,3-,5-year overall survival rates were 83.1％,63.4％,22.5％ in 68 patients with malignant tumors,89.3％,71.4％,57.1％ in 28 patients with hilar cholangiocarcinoma and 76.9％,46.2％,23.1％ in 26 with hepatocellular carcinoma.All the 56 patients with non-malignant tumors survived well.Conclusions Anatomical hepatectomy using precise surgery is safe and feasible.Preoperative precise evaluation and surgical procedure design,intraoperative vascular control and surgical plane mastering are keys to success.

Objective To study the preoperative diagnosis and treatment strategy of laparoscopic pancreatoduodenectomy (LPD) in patients with arterial anomalies.Methods The clinical data of 16 patients with arterial anomalies who underwent counterclockwise LPD at the Hunan People's Hospital from January 2016 to December 2017 were analyzed.Results The operation time was 370.0±109.0 min.The blood loss was 92.0±45.0 ml.In 14 patients,arterial anomalies were found preoperatively and were confirmed intraoperatively.The number of patients with a replaced right hepatic artery (rRHA),common hepatic artery (CHA) which originated from superior mesenteric artery (SMA),right hepatic artery (RHA) crossing in front of common bile duct (CBD),celiac artery (CA) and SMA with a common origin,right renal artery (RRA) anomaly were 5,3,3,2,and 1,respectively.In 2 patients,the anomalies were not found before operation:a dorsal pancreatic artery (DPA) originating from CHA,and a cystic artery and a right gastric artery (RGA) originating from left hepatic artery (LHA).Operative complications included biochemical fistula in 3 patients;peritoneal local effusion in 2 patients;pleural effusion in 2 patients;gastrointestinal anastomosis bleeding in 1 patient;delayed gastric emptying in 1 patient;a proper hepatic artery (PHA) pseudoaneurysm in 1 patient;and a subumbilical incision infection in 1 patient.The pathological results showed all the 16 patients had malignant tumors of the pancreas or ampulla.All the tumors were resected by R0 resection.Conclusion Arterial anomaly was common in LPD.Preoperative targeted radiological reading of X-rays,regional anatomical division combined with counterclockwise resection could result in early detection,identification and help to protect the arterial anomaly from injury and reduce the risk of serious postoperative complications.

Objective To evaluate the application value of right hemihepatic blood flow occlusion in the anatomical right posterior lobectomy. Methods Clinical data of 81 patients undergoing anatomical right posterior lobectomy in Hunan Provincial People's Hospital between January 2010 and February 2015 were retrospectively analyzed. The patients were divided into three groups according to the methods of liver blood lfow occlusion. In the right hemihepatic blood lfow occlusion group (methodⅠgroup), there were 26 cases including 12 males and 14 females with a mean of (48±9) years. In the regional blood flow occlusion of right posterior lobe group (method Ⅱ group), there were 34 cases including 15 males and 19 females with a mean of (48±10) years. In the Pringle's maneuver group (methodⅢgroup),there were 21 cases including 10 males and 11 females with a mean of (48±10) years. The informed consents of all patients were obtained and the local ethical committee approval was received. In methodⅠgroup, the right hepatic pedicle occluding band was prepared for spare, or the right hepatic artery and the right branch of portal vein were dissected and occluded separately. In methodⅡgroup, the right posterior branch of right hepatic artery and the right posterior branch of portal vein were separated, ligated and resected on the basis of methodⅠ. In methodⅢgroup, porta hepatis was not dissected. The operation time, intraoperative hemorrhage volume and blood transfusion were observed in three groups. Clinical data among three groups were compared by one-way ANOVA and LSD-t test. Results The operation time in methodⅠgroup was (168±52) min, which was significantly shorter compared with (216±39) and (193±43) min in method Ⅱ and method Ⅲgroup (LSD-t=-4.093, -1.772; P<0.05). The intraoperative hemorrhage volume in method Ⅰ group was (200±62) ml, which was signiifcantly less compared with (403±38) and (303±37) ml in methodⅡand methodⅢ group (LSD-t=-15.671, -12.735; P<0.05). Conclusion Right hemihepatic blood flow occlusion is a safe and feasible technique for controlling hemorrhage during the anatomical right posterior lobectomy, which signiifcantly decreases the intraoperative hemorrhage volume, shortens operation time and reduces surgical risk.