Objective: To investigate the resistance to rifampicin and isoniazid and the changing trends among patients with pulmonary tuberculosis in Luohu District, Shenzhen City, Guangdong Province from 2012 to 2022, so as to provide insights into improving drug-resistant pulmonary tuberculosis control and prevention strategies. Methods: Basic information, treatment classification and drug resistance data of patients with pulmonary tuberculosis and positive pathogenic detection in Luohu District from 2012 to 2022 were collected through the Tuberculosis Surveillance System of Chinese Disease Prevention and Control Information System, and resistance rates of rifampicin and isoniazid and the changing trends were analyzed. Results: A total of 2 126 patients with pulmonary tuberculosis were collected and had a median age of 34 (interquartile range, 25) years, including 1 334 males (62.75%) and 792 females (37.25%). There were 302 patients with drug-resistance in Luohu District from 2012 to 2022, with a resistance rate of 14.21%. Among them, 60 patients were monoresistant to rifampicin (2.82%), 113 patients were monoresistant to isoniazid (5.32%), and 129 patients were multidrug resistant (6.07%). The rate of rifampicin monoresistance showed a downward trend from 2012 to 2022, while the rate of multidrug resistance showed an upward trend (both P<0.05). There was no significant tendency in the rate of isoniazid monoresistance (P>0.05). The rate of multidrug resistance among patients without Shenzhen residence was higher than that among patients with Shenzhen residence; the rates of rifampicin resistance and multidrug resistance among retreated patients were higher than those among treatment-naïve patients (all P<0.05). Conclusions The rate of rifampicin monoresistance appeared a downward trend and the rate of multidrug resistance appeared an upward trend among patients with pulmonary tuberculosis in Luohu District from 2012 to 2022. Attention should be given to non-Shenzhen residence and retreated patients.

Objective:To summarize the best evidence for external auditory canal irrigation in patients with cerumen embolism.Methods:The clinical decisions, guidelines, systematic reviews, expert consensus, group standards, evidence summaries, and randomized controlled trials regarding external auditory canal irrigation in patients with cerumen embolism were retrieved from databases and websites such as BMJ Best Practice, UpToDate, Guidelines International Network, National Institute for Health and Clinical Excellence, Joanna Briggs Institute Evidence-Based Health Care Center Database, PubMed, Embase, China National Knowledge Infrastructure, WanFang data, and China Biology Medicine disc. The search period was from database establishment to February 15, 2023. Six researchers screened the literature, evaluated the methodological quality, and extracted and summarized the best evidence for external auditory canal irrigation in patients with cerumen embolism.Results:A total of nine articles were included, including one clinical decision, two guidelines, two systematic reviews, one group standard, and three randomized controlled trials. Sixteen pieces of evidence were summarized from six aspects of operators: pre-operation evaluation and preparation, operation process, post-operation handling, health education, and adverse reactions during operation.Conclusions:This paper summarizes the best evidence for external auditory canal irrigation in patients with cerumen embolism. Medical and nursing staff should carefully select and apply evidence based on clinical scenarios and patient's wishes.

Objective:To investigate the relationship between triglyceride glucos (TyG), C-reaction protein/albumin (CRP/Alb), 25-hydroxy vitamin D[25(OH)D] and the prognosis of patients with continous ambulatory peritoneal dialysis (CAPD).Methods:A total of 220 CAPD patients in the Affiliated Hospital of Jining Medical University from January 2017 to March 2020 were prospectively selected and divided into death group and survival group according to the 6-month prognosis. The peritoneal urea clearance index (Kt/V urea), TyG, CRP/Alb, 25(OH)D were compared between the two groups. Logistic regression was used to analyze the prognostic factors of CAPD patients. The predictive value of TyG, CRP/Alb and 25(OH)D on the prognosis of CAPD patients was analyzed by receiver operating characteristic (ROC) curve. Results:After 3 months and 6 months of dialysis, the peritoneal Kt/V urea in the death group [(1.21±0.18)ml/(s·1.73 m 2), (1.02±0.14)ml/(s·1.73 m 2)] was significantly lower than that in the survival group [(1.57±0.40)ml/(s·1.73 m 2), (1.49±0.42)ml/(s·1.73 m 2)] (all P<0.05). After 3 months and 6 months of dialysis, the TyG [(8.79±0.86), (9.24±1.03)] and CRP/Alb [(4.98±0.94)×10 -4, (5.14±1.39)×10 -4] in the death group were higher than those in the survival group [(8.03±0.60), (7.26±0.93), (3.57±1.19)×10 -4, (3.07±0.88)×10 -4], while the 25(OH)D [(19.14±2.29)ng/ml, (17.79±3.17)ng/ml] was lower than that of survival group [(22.67±3.03)ng/ml, (24.31±2.51)ng/ml] (all P<0.05). TyG and CRP/Alb at 3 months and 6 months of dialysis were negatively correlated with Kt/V urea, while the 25(OH)D was positively correlated with Kt/V urea (all P<0.05). Logistic regression analysis showed that Kt/Vurea, TyG, CRP/Alb and 25(OH)D were associated with prognosis in the two groups after 3 and 6 months of dialysis (all P<0.05). The AUC of TyG, CRP/Alb and 25(OH)D at 6 months of dialysis combined to predict the prognosis of CAPD patients was the highest, which was 0.911. Conclusions:TyG, CRP/Alb and 25(OH)D are associated with all-cause mortality in CAPD patients. High TyG and CRP/Alb and low 25(OH)D suggest a higher risk of all-cause mortality. Combined detection of all indicators can effectively predict the prognosis of CAPD, which is convenient for early clinical intervention.

Objective:To construct a robotic surgery nursing training model based on Kolb experience learning theory combined with the concept of enhanced recovery after surgery (ERAS) , and to explore its application effect.Methods:From February 2019 to February 2020, the "Wenjuanxing" software was used to investigate the training needs of 25 Operating Room nurses in Zhejiang Provincial People's Hospital for robotic surgery nursing. Nurses were trained according to training needs using Kolb experience learning theory and ERAS concept. The differences in theoretical assessment scores, nursing operation completion time and clinical practice comprehensive ability before and after training were compared.Results:Among 25 nurses, the theoretical knowledge score of ERAS after training was (45.16±2.03) , which was higher than that before training (27.44±2.86) , and the difference was statistically significant ( t=25.249, P<0.01) . After the training, the score of the 25 nurses in the theoretical assessment of the intraoperative fault identification and processing in robotic surgery specialist was (18.48±0.65) , which was higher than that before the training (15.12±1.51) , and the difference was statistically significant ( t=10.218, P<0.01) . In the nursing operation completion time of 25 nurses after training, the installation and adjustment time of intermittent pneumatic compression device was (2.56±0.91) min, which was shorter than that before training (4.34±1.30) min, and the difference was statistically significant ( t=5.605, P<0.01) . After the training, the time for each fault identification and processing was (1.16±0.51) min, which was shorter than (3.46±1.41) min before the training, and the difference was statistically significant ( t=7.644, P<0.01) . The score of clinical practice ability after training was (73.36±1.58) , which was higher than that before training (66.48±2.06) , and the difference was statistically significant ( t=13.241, P<0.01) . Conclusions:Kolb experience learning theory combined with ERAS concept training can improve the robotic surgery cooperation skills of Operating Room nurses, which is worthy of clinical application.

Objective:To explore the mediating effect of nurses' presenteeism behavior between job alienation and job burnout.Methods:From May 2019 to October 2021, a total of 506 nurses working in the Nursing Department of Jiaozuo People's Hospital were selected as the research objects by the convenient sampling method. General information questionnaire, Presenteeism Behavior Scale, Job Alienation Scale and Job Burnout Scale were used to investigate the nurses. Pearson correlation was used to analyze the correlation between presenteeism behavior and job burnout and job alienation, and Bootstrap test was used to explore the mediating effect. A total of 506 questionnaires were distributed and 506 were valid, with an effective recovery rate of 100.00%.Results:The total scores of job burnout, job alienation and presenteeism among 506 nurses were (63.43±8.03) , (34.16±5.55) and (6.32±1.56) , respectively. Pearson analysis showed that presenteeism was positively correlated with job alienation and job burnout ( P<0.01) . Using the Bootstrap sampling test method to conduct a mediating effect study, 95% confidence interval for the path analysis from burnout to presenteeism to job alienation did not include the number 0, and nurses' presenteeism behavior played a mediating role between job alienation and job burnout. Conclusions:Nurses have high presenteeism behavior, which plays a mediating role between job burnout and job alienation. Therefore, it is necessary to reduce the frequency of nurse presenteeism behavior and promote physical and mental health.

Objective:To investigate the changes and to establish a reference interval of bile acid profile of healthy pregnant women in the second and third trimesters of pregnancy in our hospital.Methods:A total of 298 healthy singleton pregnant women who underwent prenatal examination in the Department of Obstetrics of Zhejiang Provincial People′s Hospital from July 2019 to August 2020 were enrolled in this study. The overnight fasting serum samples were collected from all subjects during their second and third trimesters of pregnancy. The concentrations of 15 bile acids(cholic acid, chenodeoxycholic acid, deoxycholic acid, ursodeoxycholic acid, lithocholic acid and their glycine-and taurine-conjugated types)were analyzed by liquid chromatography tandem mass spectrometry (LC-MS/MS). The characteristics of changes were analyzed and the reference intervals were determined for the second and third trimesters. The concentrations of 15 bile acids and total bile acids were skewed-distributed, and 99 percentiles (P 99) were used to represent the unilateral upper limit of the reference interval. Results:There was significant difference in the serum levels of glycine cholic acid (GCA), taurocholic acid (TCA), glycine ursodeoxycholic acid (GUDCA) and lithocholic acid (LCA) between the second and third trimesters healthy pregnant females ( P<0.05). For other 11 bile acids, there was no significant difference. The levels of total bile acids, primary or secondary bile acids, free or conjugated bile acids (glycine-bound and taurine-bound bile acids) were stable with gestation. Conclusion:Primary, secondary or free, and conjugated bile acids in healthy pregnant women remained stable at T 2 and T 3, with significant differences in only a few subtypes of bile acids. While the correlation between glycine-bound and taurine-bound bile acids showed a weakening trend at T 3 ( P<0.05). It is necessary to establish reference intervals of bile acids for healthy pregnant women in this area. This study provided data support for future research on related diseases during pregnancy.

Objective: To improve the diagnosis and therapy of childhood pulmonary thromboembolism (PTE) by analyzing the clinical features of this rare condition. Methods: A total of 8 pediatric patients (4 males, 4 females) with PTE diagnosed in the Children′s Hospital of Zhejiang University School of Medicine from March, 2014 to March, 2019 were enrolled. The clinical manifestation, laboratory results, imaging findings, diagnosis and treatment were summarized. Results: Among these 8 cases, aged from 9 hours to 14 years and 10 months. Fever was found in 4 cases, cough aggravation in 4, short of breath in 3, chest pain in 2, abdominal and back pain in one, hemoptysis in 2, cyanosis in 1, and edema of lower extremities in 2. Physical examination found decreased breath sound in 2 cases, phlegm rale in 3, and pleural friction rub in one. Pleural effusion was found in 5 cases by ultrasound. Plasma D-dimer increased in 6 cases (0.66-9.96 mg/L) and hypersensitive C-reactive protein elevated in 5 cases (10.78-78.00 mg/L). Chest enhanced CT showed pulmonary artery or venous filling defects, including pulmonary artery embolism in 7 cases and pulmonary vein embolism in one. The primary disease of these patients included Mycoplasma Pneumoniae pneumonia in 4 cases, nephritis in 2 and postoperative congenital heart disease in 2. Apart from one case who withdrew the treatment and was discharged, the other 7 patients received anticoagulant treatment had good outcome. Conclusions For children with Mycoplasma pneumoniae pneumonia, immune disorders, long-term hormone therapy, cardiovascular invasive operation or other high-risk factors, PTE should be considered when fever, cough aggravation, short of breath, chest and back pain with pleural effusion are present. Chest enhanced CT scan should be performed as soon as possible, and anticoagulation should be started once the diagnosis is confirmed.

Objective:To standardize the management of instruments, catheters, and wires around the operating field of complex endoscopic surgery, develop and optimize an integrated control device for complex endoscopic operating table, and explore its effects.Methods:By convenient sampling, totally 386 complex endoscopic surgeries performed in Zhejiang Provincial People's Hospital from October 2018 to July 2019 which met the inclusion criteria were selected into the observation group, while 382 complex endoscopic surgeries performed from December 2017 to September 2018 which met the inclusion criteria were selected into the control group. For the observation group, the optimized integrated control device for complex endoscopic operating table was used to fix catheters and pipelines around the surgical field and place operating instruments that were connected to the catheters and wires or used frequently and alternately during surgery. For the control group, tissue forceps and operating towels were used to fix catheters and pipelines around the surgical field and while operating instruments that were connected to the catheters and wires or used frequently and alternately during surgery were randomly placed around the surgical field. The number of contaminated endoscopic instruments by fall, the number of damaged endoscopic instruments during surgery, the time for fixing the catheters and wires around the surgical field, and the time required to replace one piece of operating instrument were compared between the two groups.Results:The number of contaminated endoscopic instruments by fall during surgery in the observation group was less than that in the control group, and the difference between the two groups was statistically significant ( P< 0.01) . The number of damaged endoscopic instruments by fall during surgery in the observation group was less than that in the control group, and the difference between the two groups was statistically significant ( P< 0.05) . The time for fixing the catheters and wires around the surgical field in the observation group was less than that in the control group, and the difference between the two groups was statistically significant ( P< 0.01) . The time required for the surgeon to replace one piece of operating instrument in the observation group was less than that in the control group, and the difference between the two groups was statistically significant ( P< 0.01) . Conclusions:The optimized integrated control device for complex endoscopic operating table standardizes the management of catheters, pipelines, and instruments that are frequently and alternately used during surgery of complex endoscopic fields, reduces the number of contaminated and damaged endoscopic instruments by fall, ensures the successful surgical process, and improves the efficiency of the operating room.

Vitamins are classified as either fat-soluble (vitamins A, D, E, K) or water-soluble (vitamins B and vitamin C). Traditional methods of immunoassay have only been developed for vitamins D,B6, B9 and B12. However, they cannot distinguish between vitamin subtypes such as D2, D3 and associated epi isomers (which has higher leveks in infants),giving false positive or negative results. Mass spectrometry has become a gold standard method for small molecule analysis in biological samples with its advantages in speed,resolution,sensitivity and specificity. It is widely used in clinical research and diagnosis and provides an efficient method for simultaneous detection of multivitamins in one injection using one low volume sample collection.

Objective? To explore the application of intelligent operation arrangement software in shift scheduling in Gynecological Laparoscopic Operating Room. Methods? From January 2013 to December 2017, 13 905 patients' profiles of gynecological laparoscopic surgery in the Gynecological Laparoscopic Operating Room of Zhejiang Provincial People's Hospital were collected. The daily operation volume, specific time of single operation, preparation time of different types of gynecological laparoscopic surgery, and special instruments transmission for gynecological laparoscopic surgery and time of patients' awakening from anesthesia and transfer were analyzed and counted. A database of specialist operations was established. Weights were determined according to key information and data, and relevant calculation formulas were formulated for data calculation. Artificial intelligence scheduling was carried out on the basis of original operation arrangement by simulation and comparison. Results? The average annual, monthly, weekly and daily operation volume from 2013 to 2017 were 1 005.7, 85.6, 24.2 and 6.8, respectively. There were statistically significant differences in the average operation time of single gynecological laparoscopic surgery between different medical groups (P＜ 0.05). The data of different types of gynecological laparoscopic surgery such as interval preparation time, material flow transmission of gynecological laparoscopic surgical instruments and transfer time of anesthesia recovery were input into computer to establish and improve the database of gynecological laparoscopic surgery. The measurement model of different types of operation interval distribution was designed and completed, which improved the accuracy of time estimation and reliability of simulated intellectualized surgical planning . After adopting the intelligent simulation operation arrangement scheme to improve the efficiency of operation room and give priority to the humanization of operation team and patients, the service time for daily use of operating room was saved about 90 minutes and 45 minutes respectively compared with the traditional editor's shift scheduling. Conclusions? Intelligent operation arrangement software can improve the efficiency of operating room for gynecological laparoscopic surgeries and gradually meet the humanistic needs of both doctors and patients in the process of operation. Through the development of internal and external interfaces, the hospital's intelligent and information management can be further improved.