Establishing a full-cycle contract management model for comprehensive public hospitals has practical signifi-cance for the development of smart hospitals.The aim is to create a hierarchical and classified contract management system fo-cused on information sharing.The method involves outlining the systematic processes of contract management within the hospital,analyzing common issues from multiple dimensions-such as management processes,level of information technology,and process supervision-and proposing solutions to meet the requirements of modern public smart hospital contract management.Based on in-formation sharing and hierarchical management,this approach offers ideas for refined management in hospitals and promotes the high-quality development of comprehensive medical services in smart hospitals..

Objective:To evaluate the effectiveness of oral-nasal oxygen supply mouth guard in painless gastroscopy for snoring patients.Methods:The snoring patients who underwent painless gastroscopy at two Endoscopy Centers of Shanghai East Hospital, Tongji University in July 2022 were randomly divided into the observation group (using oral-nasal oxygen supply mouth guard) and the control group (using ordinary nasal oxygen tube and mouth guard). Parameters such as the wearing time and the removal time of the mouth guard, lowest pulse oxygen saturation (SpO 2), incidence of hypoxemia, and the satisfaction of medical staff were compared between the two groups. Results:The wearing time of mouth guard was 11.63±0.84 seconds and the removal time was 5.33±0.76 seconds in the observation group ( n=40), which were lower than those in the control group ( n=47) (14.91±1.21 seconds, t=-14.463, P<0.001; 10.38±0.80 seconds, t=-30.095, P<0.001). The wearing satisfaction score was 9.80±0.61, the lowest SpO 2 was (96.70±3.42)%, the removal satisfaction score was 9.75±0.67, and the anesthesiologists' satisfaction score was 9.20±1.42 in the observation group, which were higher than those in the control group [7.70±0.93, t=12.209, P<0.001; (94.06±3.72)%, t=3.417, P=0.001; 7.96±0.98, t=9.803, P<0.001; 8.13±1.35, t=3.615, P=0.001] with significant difference. There was no significant difference in the incidence of hypoxemia [10.00% (4/40) VS 14.89% (7/47), χ2=0.130, P=0.718] and endoscopic physician satisfaction score (9.30±0.97 VS 9.02±1.31, t=1.112, P=0.269) between the two groups. Conclusion:The oral-nasal oxygen supply mouth guard is easy to wear and remove, effectively reducing SpO 2 fluctuations during painless gastroscopy for snoring patients. It can enhance medical staff satisfaction with high clinical value.

Objective:To investigate the incidence and related risk factors of refeeding syndrome (RFS) in patients with severe stroke.Methods:Patients with severe stroke admitted to the Department of Neurology, the First Affiliated Hospital of Soochow University underwent nutritional treatment again after fasting between December 2017 and October 2022 were included retrospectively. The incidence of RFS in patients with severe stroke was summarized. Multivariate logistic regression models were used to analyze the independent risk factors for RFS. A restricted cubic spline model was used to explore the dose-response relationship between relevant indicators and RFS. Results:A total of 188 patients were included, including 108 males and 80 females, with a median age of 72 years (interquartile range, 63-77 years); 185 patients (98.4%) had ischemic stroke and 3 (1.6%) had cerebral hemorrhage; 59 (31.4%) received enteral nutrition, 36 (19.1%) received gastrointestinal decompression, 30 (16.0%) received mechanical ventilation; and 60 patients (31.9%) developed RFS. Multivariate logistic regression analysis showed that serum creatinine (odds ratio [ OR] 1.011, 95% confidence interval [ CI] 1.001-1.020; P=0.025), serum potassium ( OR 8.349, 95% CI 3.025-23.039; P<0.001), serum phosphorus ( OR 46.578, 95% CI 6.444-336.661; P<0.001) and diabetes ( OR 2.173, 95% CI 1.087-4.345; P=0.028) were the independent risk factors for the occurrence of RFS. The restricted cubic spline model analysis showed that there was a non-linear relationship between serum creatinine and RFS, and the increased risk of RFS showed an "S" shape with the increase of serum creatinine. When serum creatinine exceeded 70.68 μmoI/L, the risk of RFS continued to increase. There was no non-linear relationship between serum phosphorus and serum potassium and RFS. Conclusions:Serum creatinine, serum phosphorus, serum potassium and diabetes are the independent risk factors for RFS in patients with severe stroke. These risk factors should be utilized to identify the high-risk patients with RFS early and the targeted measures should be taken as soon as possible.

Objective:To develop a questionnaire on knowledge, attitude and practice of Helicobacter pylori (Hp) infection among physical examination population, and to verify its reliability and validity.Methods:This study was a cross-sectional survey. Based on the theory of knowledge, attitude and practice, the first draft of the questionnaire on knowledge, attitude and practice of Hp infection in physical examination population was designed by means of retrospective literature research, qualitative interview, discussion in the research group. The structure and items of the questionnaire were consulted and revised by the expert consultation method (Delphi method). Through pre investigation of 186 physical examination personnel from May to June in 2021, the final version of the "knowledge, attitude and practice questionnaire on Helicobacter pylori infection among physical examination population" was formed after adjustment and verification of the reliability and validity of the questionnaire.Results:The questionnaire of knowledge, attitude and practice of Hp infection in physical examination population included 3 dimensions and 28 items, and the cumulative variance contribution rate was 56.271%. The content validity index of each item level of the questionnaire was 0.75-1.00, and the content validity index of the total questionnaire was 0.94. The Cronbach alpha of knowledge, attitude and practice dimensions in this questionnaire were 0.862, 0.901 and 0.798 respectively. The overall Cronbach alpha of the questionnaire was 0.890, and the half reliability was 0.698. The test-retest reliability of the questionnaire was 0.919, and the test-retest reliability of each dimension was 0.924, 0.917 and 0.845.Conclusions:The questionnaire has good reliability and validity, and can be used to measure the level of knowledge, attitude and practice of Hp infection in physical examination population.

Tumor metastasis depends on the dynamic balance of the actomyosin cytoskeleton. As a key component of actomyosin filaments, non-muscle myosin-IIA disassembly contributes to tumor cell spreading and migration. However, its regulatory mechanism in tumor migration and invasion is poorly understood. Here, we found that oncoprotein hepatitis B X-interacting protein (HBXIP) blocked the myosin-IIA assemble state promoting breast cancer cell migration. Mechanistically, mass spectrometry analysis, co-immunoprecipitation assay and GST-pull down assay proved that HBXIP directly interacted with the assembly-competent domain (ACD) of non-muscle heavy chain myosin-IIA (NMHC-IIA). The interaction was enhanced by NMHC-IIA S1916 phosphorylation via HBXIP-recruited protein kinase PKCβII. Moreover, HBXIP induced the transcription of PRKCB, encoding PKCβII, by coactivating Sp1, and triggered PKCβII kinase activity. Interestingly, RNA sequencing and mouse metastasis model indicated that the anti-hyperlipidemic drug bezafibrate (BZF) suppressed breast cancer metastasis via inhibiting PKCβII-mediated NMHC-IIA phosphorylation in vitro and in vivo. We reveal a novel mechanism by which HBXIP promotes myosin-IIA disassembly via interacting and phosphorylating NMHC-IIA, and BZF can serve as an effective anti-metastatic drug in breast cancer.

Objective:To investigate the clinicopathologic characteristics, gene mutation profile and prognostic influencing factors of diffuse large B-cell lymphoma (DLBCL) complicated with follicular lymphoma (FL) (DLBCL/FL).Methods:The clinicopathological data of 50 DLBCL/FL patients admitted to Rui Jin Hospital Affiliated of Shanghai Jiao Tong University School of Medicine from February 2018 to November 2021 were retrospectively analyzed. Targeted sequencing was performed to assess the mutation profile of 55 lymphoma-related genes. The clinicopathological characteristics were summarized to evaluate the short-term therapeutic efficacy of all patients. Kaplan-Meier method was used to analyze the overall survival (OS) and progression-free survival (PFS) of patients. Cox regression risk models were used to assess the factors affecting the OS and PFS.Results:Among 50 DLBCL/FL patients, 23 cases (46%) were male, 22 cases (44%) had an international prognosis index (IPI) score ≥ 2 points, 16 cases (32%) were double-expression lymphoma (DEL) and 4 cases (8%) were double-hit lymphoma (DHL). The complete response (CR) and overall response rates were 68% (34/50) and 78% (39/50), respectively after the first-line therapy. The median follow-up time was 23.3 months (5.1-50.9 months). The 2-year OS rate was 82.1% and 2-year PFS rate was 67.1%; and the median OS and PFS were not reached. Targeted sequencing results showed that the mutation frequencies of KMT2D, MYD88, TP53, BTG2, DTX1, EZH2, CD70, CREBBP, DUSP2, HIST1H1C, HIST1H1E and PRDM1 genes in this cohort were more than 15%. Multivariate Cox regression analysis showed that male ( HR = 4.264, 95% CI 1.144-15.896, P = 0.031) and IPI score ≥ 2 points ( HR = 6.800, 95% CI 1.771-37.741, P = 0.007) were independent risk factors of PFS in newly diagnosed DLBCL/FL patients, and TP53 mutation ( HR = 4.992, 95% CI 1.027-24.258, P = 0.046) was an risk influencing factor of OS. Conclusions:The proportion of male and female DLBCL/FL patients is similar, with a small proportion of DHL. Mutations of KMT2D, MYD88 and TP53 genes are commonly found in DLBCL/FL patients. Generally, DLBCL/FL patients can have a high overall response and good prognosis. Male and IPI score ≥ 2 points are the independent risk factors of PFS, and TP53 mutation is an independent risk factor of OS in DLBCL/FL patients.

Traditional symptom management methods are difficult to efficiently and accurately intervene in symptom networks related to mental illness. Bridge symptoms are the most core symptom in the symptom network, and symptom management for bridge symptoms can effectively improve other related symptoms management of mental illness. This paper reviews the overview, identification indicators and methods, characteristics of bridge symptoms, and its application significance in symptom management of mental illness patients, aiming to provide reference for nurses to implement efficient and accurate symptom management for patients with mental illness.

Objective:To explore the prognostic value of lymphocyte subsets in adult hemophagocytic syndrome (HPS).Methods:A total of 172 adult HPS patients diagnosed in 8 medical centers from January 2013 to August 2020 were selected for the study, of whom 87 were male (50.6%, 87/172), and 85 were female (49.4%, 85/172), with 68 survivors and 104 deaths. The clinical data were summarized, and variables such as lymphocyte subsets, immunoglobulin characteristics and fibrinogen were retrospectively analyzed, and the correlation between the mentioned variables and patient prognosis was analyzed. The optimal cut-off values of continuous variables were calculated by MaxStat, and the prognostic factors of HPS patients were screened based on the Cox proportional hazard regression model.Results:The median age of HPS patients was 56 (42, 66) years old, and the 5-year cumulative survival rate was 37.4% (37.4/100). The median age, platelet and albumin were 48 (27, 63) years, 84×10 9/L and 32.3 g/L in the survival group, and 59 years, 45.5×10 9/L, and 27.3 g/L in the death group, respectively. The differences between the two groups was statistically significant ( Z=?3.368, P=0.001; Z=?3.156, P=0.002; Z=?3.431, P=0.001). Patients with differentiated cluster 8+(CD8+)<11.1%, CD3+<64.9%, CD4+>51%, and CD4/CD8 ratio>2.18 had poor prognosis (χ 2=7.498, P=0.023; χ 2=4.169, P=0.041; χ 2=4.316, P=0.038; χ 2=9.372, P=0.002). Multivariable analysis showed that CD4/CD8 ratio, age, fibrinogen and hemoglobin were independent prognostic factors in HPS patients ( HR=2.435, P=0.027; HR=5.790, P<0.001; HR=0.432, P=0.018; HR=0.427, P=0.018). Conclusion:Peripheral blood lymphocyte subsets can be used to evaluate the prognosis of patients with HPS; CD4/CD8 ratio, age, fibrinogen, and hemoglobin are independent prognostic factors in HPS patients.

Objective:To construct the delirium prevention nursing program in ICU children and explore its clinical effect.Methods:The literature analysis and expert meeting method were used to construct the delirium prevention nursing program in ICU children. Using the convenient sampling method, a total of 315 ICU children who were admitted to Children's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from February to July 2020 were selected as the control group and 309 ICU children admitted from August 2020 to January 2021 were selected as the experimental group. The control group adopted routine nursing, while the experimental group adopted delirium prevention nursing program in ICU children on the basis of routine nursing. The differences in the incidence of delirium, mechanical ventilation time, ICU stay and ICU costs were compared between the two groups.Results:After the intervention, the incidence of delirium in the experimental group was 15.9% (49/309) and the ICU stay was 4.0 (2.5, 7.0) days, which were lower than 29.2% (92/315) and 5.0 (3.0, 10.0) d in the control group, and the differences were statistically significant (χ 2=15.892, Z=-2.341; P<0.05) . Conclusions:The establishment and application of delirium prevention nursing program for ICU children can effectively reduce the incidence of delirium in ICU children and length of stay in ICU.

Objective:To construct a risk prediction model for ICU delirium in patients with brain tumor surgery, and to verify the application value of the model in predicting the risk of ICU delirium in patients with brain tumor.Methods:Using the convenient sampling method, a total of 336 postoperative patients with brain tumors who were admitted to Neurosurgery ICU of East Hospital Affiliated to Tongji University from December 2020 to July 2021 were selected as the modeling group. Patients were divided into the delirium group ( n=101) and the non-delirium group ( n=235) according to the occurrence of ICU delirium. The patients were evaluated using Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and Richmond Agitation Sedation Score (RASS) . Univariate analysis and binomial logistic regression analysis were used to explore the influencing factors of ICU delirium in patients after brain tumor surgery and to construct a predictive model. The area under receiver operating characteristic curve ( AUC) and Calibration curve were used to evaluate the discrimination and calibration of the model. The model was validated by 1 000 Bootstrap self-sampling methods. According to the same criteria, a total of 144 patients with brain tumors from August to November 2021 were selected as the validation group to verify the model. Results:The predictors that finally entered the model were age ( OR=1.033) , length of stay in neurosurgical ICU ( OR=1.298) , length of operation ( OR=1.006) , use of benzodiazepines ( OR=5.850) , physical restraint ( OR=2.820) , tumor diameter ( OR=1.385) and bilateral brain tumor mass ( OR=3.604) . The prediction model of AUC was 0.935 (95% CI: 0.911-0.960, P<0.01) , the Youden index was 0.747, the sensitivity was 92.1% and the specificity was 82.6%. The internal validation consistency index of the Bootstrap method was 0.916, and the calibration curve fit the ideal curve well. The model validation results showed that the sensitivity was 86.4%, the specificity was 85.0%. Conclusions:The prediction model of delirium risk in ICU patients after brain tumor surgery has good predictive performance, which can provide reference for medical staff to take preventive management measures in the early stage.