Psychological factors have become significant contributors to the onset and progression of insomnia. This article explored the treatment of insomnia from the perspective of “liver governs wei qi （defensive qi）”. The concept of “liver governs wei qi （defensive qi）” is summarized in three aspects， firstly， the liver assists the spleen and stomach in transformation and transportation， governing the generation of wei qi； secondly， the liver aids lung qi diffusion and dispersion， governing the distribution of wei qi； thirdly， the liver regulates circadian rhythms， governing the circulation of wei qi. It is proposed that the clinical treatment of insomnia should focus on the following methods： for regulating the liver to harmonize the five viscera， and facilitate the circulation of wei qi， medicinals entering the liver channel include Chaihu （Bupleuri radix）， Baishao （Paeoniae Radix Alba）， Zhizi （Gardeniae Fructus）， and Suanzaoren （Ziziphi Spinosae Semen） could be commonly used； for nourishing the liver， the treatment should align with the day-night rhythm， and herbs such as Baihe （Lilium）， Hehuan （Albizia julibrissin）， and Yejiaoteng （Polygoni multiflori caulis） are commonly used； for soothing the liver and address both mental and physical health to calm wei qi， treatment should advocate verbal counseling， psychological regulation， and health education. Ultimately， this treatment approach can free liver qi to flow， soothe qi movement， restore the motion of wei qi， regulate during day and night， balance yin and yang， and resolve insomnia effectively.

The acute combination fractures of the atlas and axis in adults have a higher rate of neurological injury and early death compared with atlas or axial fractures alone. Currently, the diagnosis and treatment choices of acute combination fractures of the atlas and axis in adults are controversial because of the lack of standards for implementation. Non-operative treatments have a high incidence of bone nonunion and complications, while surgeries may easily lead to the injury of the vertebral artery, spinal cord and nerve root. At present, there are no evidence-based Chinese guidelines for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults. To provide orthopedic surgeons with the most up-to-date and effective information in treating acute combination fractures of the atlas and axis in adults, the Spinal Trauma Group of Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field of spinal trauma to develop the Evidence-based guideline for clinical diagnosis and treatment of acute combination fractures of the atlas and axis in adults ( version 2023) by referring to the "Management of acute combination fractures of the atlas and axis in adults" published by American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) in 2013 and the relevant Chinese and English literatures. Ten recommendations were made concerning the radiological diagnosis, stability judgment, treatment rules, treatment options and complications based on medical evidence, aiming to provide a reference for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults.

Objective:To summarize the construction experience of the cardiorespiratory rehabilitation specialist nurse practice base under the integration of Shenzhen and Hong Kong, so as to provide excellent practice bases for cardiorespiratory rehabilitation specialist nurses.Methods:This study constructed a training course system for practice bases, set up clinical practice courses, and improved the professional literacy and practical skills of cardiorespiratory rehabilitation specialty nurses through theoretical assessment, mind mapping, case reporting, and simulation assessment.Results:Cardiopulmonary rehabilitation specialist nurses all passed the operational assessment of the Nursing Committee of the Chinese Association of Rehabilitation Medicine and obtained completion certificates. The care report performance of cardiorespiratory rehabilitation specialist nurses improved compared to the training period, with a statistically significant difference ( P<0.001) . Conclusions:The standardized practice base training lays a solid foundation for cultivating excellent and high-quality cardiorespiratory rehabilitation specialist nurses, promoting the development of cardiorespiratory rehabilitation in China.

Objective:To construct an unaccompanied patient ward management system based on the harmony theory and explore its effects in the Department of Breast and Plastic Surgery.Methods:Patients from the Department of Breast and Plastic Surgery, the University of Hong Kong-Shenzhen Hospital from January to July 2021 were selected as the control group ( n=1 213) , who received conventional accompanied care. Those admitted from January to July 2022 were the observation group ( n=1 057) , who received harmonious unaccompanied care. The occurrence rate of adverse events, patient satisfaction, and medical staff's job satisfaction between the two groups were compared. Results:The occurrence rate of adverse events in the observation group (0/1 057) was lower than that in the control group (1/1 213) , with no statistically significant difference ( P>0.05) . Both patients' satisfaction and medical staff's job satisfaction in the observation group were higher than those in the control group, with statistically significant differences ( P<0.05) . Conclusions:The construction of the unaccompanied patient ward management system based on the harmony theory contributes to standardizing high-quality nursing comprehensively. It improves both patients' satisfaction and medical staff's job satisfaction, promoting harmonious doctor-patient relationships.

Objective:To understand the work and training status of multi-region medical nursing assistants, and provide reference for standardizing the admission qualification of medical nursing assistants and improving the training system of them.Methods:Using the purposive sampling method, in-depth interviews were conducted among 19 medical nursing assistant managers and 20 medical nursing assistants from 13 large general hospitals in China from October to November 2021. Colaizzi 7-step analysis method was used to analyze data and extract themes.Results:Two themes of status of training of medical nursing assistants and managers' expectations for the development of the medical nursing assistants industry were extracted. It included 7 sub-topics, including insufficient pre-job training hours and relative single content, low on-the-job training coverage, the need to improve the practicality of training, urgent improvement of assessment system, standardization of admission qualifications for medical nursing assistants, establishment of training structure for medical nursing assistants and implementation of graded nursing care for medical nursing staff.Conclusions:The admission qualification of medical nurses should be strictly regulated, the government should take the lead in formulating standardized and professional pre-job training programs, carry out hierarchical, focused and multi-form on-the-job training, build a training and assessment system including "process evaluation" and "final evaluation", and implement hierarchical employment to stabilize the team of medical nursing assistants.

Objective:To explore the effects and possible mechanisms of melatonin combined with enriched environment on the learning and memory ability of senescence-accelerated mouse prone 8(SAMP8).Methods:Forty-eight SAMP8 male mice aged 4 months were randomly divided into model group, enriched environment group, melatonin group and melatonin combined with enriched environment group (combined intervention group) by random number table method, with 12 mice in each group. Mice in the melatonin group and combined intervention group were subcutaneously injected with melatonin at a dose of 8 mg·kg -1·d -1, and the mice in the model group and the enriched environment group were given the same amount of normal saline instead.The mice in model group and melatonin group were raised in a standard environment, and the mice in enriched environment group and combined intervention group were raised in an enriched environment.The intervention lasted 28 days. The aging degree of mice was scored before and 28 days after the intervention. Morris water maze test was used to detect the learning and memory ability of mice. Nissl staining and TUNEL staining were used to observe the Nissl staining positive cells and apoptotic cells in the CA1 area of hippocampus.ELISA was used to detect the levels of interleukin-1β (IL-1β), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in the hippocampus of mice. Western blot was used to detect the levels of amyloid β-protein (Aβ) 1-42, microtubule-associated protein tau (tau) phosphorylated at threonine (Thr) 205 (Tau pT205), Toll-like receptor 4 (TLR4), and nuclear factor-κB (NF-κB) p65 protein in the hippocampus of mice. qRT-PCR was used to detect the levels of TLR4, NF-κB p65 mRNA in the hippocampus of mice. SPSS 22. 0 statistical software was used for repeated measure ANOVA, one-way ANOVA and LSD test. Results:(1) Aging score: after intervention, the aging scores of mice in the four groups were significantly different ( F=120.601, P<0.01). The aging scores of mice in the enriched environment group, melatonin group, and combined intervention group were lower than those in the model group (all P<0.05), while the aging score of mice in the combined intervention group was significantly lower than those in the enriched environment group and melatonin group (both P<0.05). (2) The results of the location navigation experiment showed that the time × group interaction effect of the escape latencies of mice in the four groups were significant ( F=30.524, P<0.001). From the 2nd to 4th day, the escape latencies of mice in the enriched environment group, melatonin group and combined intervention group were all lower than that in the model group (all P<0.05). The results of the space exploration experiment showed that the residence time in the target quadrant and the number of platform crossings of mice in the four groups were significantly different ( F=291.328, 113.482, both P<0.01). The residence time in the target quadrant ((29.45±1.70)s, (32.44±1.55)s, (37.48±0.84) s) and the number of platform crossings ((6.44±0.61) times, (7.16±0.70) times, (12.60±1.23) times) of mice in the enriched environment group, melatonin group and combined intervention group were higher than those in the model group ((15.07±1.28) s, (4.10±0.61) times), while the residence time in the target quadrant and the number of platform crossings of mice in the enriched environment group and the melatonin group were significantly lower than those in the combined intervention group (all P<0.05). (3) Nissl and TUNEL staining showed that the number of Nissl positive neurons in the hippocampal CA1 region of mice in the four groups were significantly different ( F=809.264, P<0.01), and the number of apoptotic cells in the hippocampal CA1 region were also significantly different ( F=1 060.583, P<0.01). The number of Nissl stained positive neurons in the hippocampal CA1 region of mice in the combined intervention group was more than those in the model group, enriched environment group, and melatonin group (all P<0.05), and the number of apoptotic cells were less than those in the model group, enriched environment group, and melatonin group (all P<0.05). (4) The results of ELISA assay showed that there were significantly different in the levels of IL-1β, IL-6 and TNF-α in the hippocampus of mice in the four groups ( F=152.887, 63.506, 432.026, all P<0.01). The contents of IL-1β, IL-6 and TNF-α in the hippocampus of mice in the enriched environment group, melatonin group, and combined intervention group were lower than those in the model group(all P<0.05). Among them, the contents of IL-1β, IL-6 and TNF-α in the hippocampus of mice in the enriched environment group and melatonin group were significantly higher than those in the combined intervention group (all P<0.05). (5) Western blot analysis showed that there were significantly different in the protein expression levels of Aβ1~42, tau pT205, TLR4, NF-κB p65 in the hippocampus of mice in the four groups ( F=122.349, 98.934, 201.635, 116.553, all P<0.01). The protein expression levels of Aβ1-42, tau pT205, TLR4, and NF-κB p65 in the hippocampus of mice in the enriched environment group, melatonin group, and combined intervention group were lower than those in the model group.Among them, the protein expression levels of Aβ1-42, tau pT205, TLR4, NF-κB p65 in the hippocampus of mice in the enriched environment group and melatonin group were significantly higher than those in the combined intervention group (all P<0.05). (6) qRT-PCR showed that the mRNA expression levels of TLR4 and NF-κB p65 in the hippocampus of mice in the four groups were significantly different ( F=42.913, 102.446, both P<0.01). The mRNA expression levels of TLR4 ((0.63±0.05), (0.55±0.04), (0.42±0.03)) and NF-κB p65 ((0.98±0.06), (0.82±0.04), (0.72±0.04)) in the hippocampus of mice in the enriched environment group, melatonin group and combined intervention group were lower than those in the model group ((0.74±0.07), (1.20±0.05)) (all P<0.05). Among them, the mRNA expression levels of TLR4 and NF-κB p65 in the hippocampus of mice in the enriched environment group and melatonin group were significantly higher than those in the combined intervention group (all P<0.05). Conclusion:Melatonin combined with enriched environment can improve the learning and memory ability and neuroinflammatory response of SAMP8 mice, and its mechanism may be related with the down-regulation of TLR4/NF-κB p65 signaling pathway.

Osteoporotic vertebral compression fracture (OVCF) can lead to lower back pain and may be even accompanied by scoliosis, neurological dysfunction and other complications, which will affect the daily activities and life quality of patients. Vertebral augmentation is an effective treatment method for OVCF, but it cannot correct unbalance of bone metabolism or improve the osteoporotic status, causing complications like lower back pain, limited spinal activities and vertebral refracture. The post-operative systematic and standardized rehabilitation treatments can improve curative effect and therapeutic efficacy of anti-osteoporosis, reduce risk of vertebral refracture, increase patient compliance and improve quality of life. Since there still lack relevant clinical treatment guidelines for postoperative rehabilitation treatments following vertebral augmentation for OVCF, the current treatments are varied with uneven therapeutic effect. In order to standardize the postoperative rehabilitation treatment, the Spine Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized relevant experts to refer to relevant literature and develop the "Guideline for postoperative rehabilitation treatment following vertebral augmentation for osteoporotic vertebral compression fracture (2022 version)" based on the clinical guidelines published by the American Academy of Orthopedic Surgeons (AAOS) as well as on the principles of scientificity, practicality and advancement. The guideline provided evidence-based recommendations on 10 important issues related to postoperative rehabilitation treatments of OVCF.

Objective:To explore the teaching effect of Evidence-based Nursing course for undergraduate nursing students.Methods:From July to August 2020, 80 undergraduate nursing students from Xiamen University in 2017 and 2018 were selected as research objects by convenience sampling. Among the students, nursing undergraduates in 2017 were in the control group ( n=38) , and nursing undergraduates in 2018 who chose this course were in the test group ( n=42) . The Chinese version of the Evidence-Based Practice Knowledge, Attitude, Behavior Questionnaire and the Chinese version of the Critical Thinking Disposition Inventory (CTDI) were used to compare the evidence-based practice ability and critical thinking ability of the two groups of undergraduates. Results:The scores and total scores of three dimensions of evidence-based practice behavior, attitude and knowledge in the test group were higher than those in the control group, and the score of critical thinking ability of the test group was higher than that of the control group, with statistically significant differences ( P<0.01) . Conclusions:Setting up Evidence-based Nursing course for undergraduate nursing students can effectively improve students' knowledge, attitude and behavior and critical thinking ability of evidence-based nursing, and it is also conducive to the unification of clinical practice and classroom environment, promoting the development of nursing discipline and nursing cause in China.

Objective:To investigate the level of suicide ideation of female nurses in the public grade A hospitals of Fujian Province, and to explore the influence of impulsive personality and social support on the suicidal ideation of nurses.Methods:A total of 1 000 female nurses from a number of public grade A hospitals in Fujian Province were investigated by convenient sampling method from March to October 2019, using Barratt impulsive personality scale, social support scale and suicide ideation scale were used for the survey.Results:The prevenlence of suicidal ideation was 9.74%. Social support was negatively correlated with impulsive personality and suicidal ideation, and impulsive personality was positively correlated with suicidal ideation ( r=-0.329, -0.449, 0.291, P<0.01). The social support had an indirect mediating effect on the influence of impulsive personality on suicidal ideation. Conclusions:Nursing managers can promote the level of social support of nurses and reduce the intensity of suicidal ideation.