Objective To construct and apply a management plan for microaspiration of oropharyngeal secretions in ICU intubated patients.Methods Based on evidence summaries and expert consultation,a management plan for microaspiration of oropharyngeal secretions in ICU intubated patients was constructed,consisting of 19 items covering 7 aspects including identification of risk factors,position management,tube and cuff selection,cuff management,mechanical ventilation management,pain and sedation management,removal of oropharyngeal and subglottic secretions,and oral care.Convenience sampling was used to select 141 ICU intubated patients from a tertiary A comprehensive hospital in Suzhou from June,2022 to September,2023.Patients were divided into an experimental group(n=72)and a control group(n=69)according to the wards.The experimental group received the management plan for microaspiration of oropharyngeal secretions in ICU intubated patients.The control group received the nursing bundle for ventilator associated pneumonia(VAP).The incidence and time from intubation to microaspiration and VAP,duration of mechanical ventilation,ICU length of stay,and disease outcome were compared between the 2 groups.Results The incidence of microaspiration of oropharyngeal secretions,the duration of mechanical ventilation,time from intubation to microaspiration showed significant differences between the 2 groups(P<0.05).There were no significant differences in the incidence of ventilator associated pneumonia,ICU length of stay,and disease outcome between the 2 groups(P>0.05).The time from intubation to VAP in the experimental group was 7.5 days,and that in the control group was 3.8 days.Conclusion The application of the management plan for microaspiration of orophaiyngeal secretions in ICU intubated patients is beneficial for reducing the incidence of microaspiration,delaying the time from intubation to microaspiration and VAP,and shortening the duration of mechanical ventilation.

Objective To explore the clinical application effect of scenario-driven unscripted emergency drills.Methods A total of 120 nursing staff who underwent scripted drills from January 2019 to July 2021 were selected as convention group,and 120 nursing staff who underwent scenario-driven unscripted emergency drills at Ganzhou Women and Children's Health Care Hospital from August 2021 to July 2023 were selected as drill group.The two groups were compared in terms of availability of per-sonnel and materials,performance of duties,personnel protection,coordination and organization,division of labor in emergency teams,actual combat effectiveness,partial cooperation and assistance,handling of emergencies,and first aid awareness.Results The drill group demonstrated a higher proportion of personnel who arrived quickly,accurately,and basically on time compared to the convention group.The drill group showed a significantly lower proportion of individual personnel who were not in place and key position personnel who were not in place compared to the convention group(P＜0.05).The drill group performed signifi-cantly better than the convention group(P＜0.05).The drill group did better in on-site material preparation all as well as in per-sonnel protection compared to the convention group.The drill group had a more accurate and efficient overall organization than the conventional group,and the emergency team of the drill group had a more reasonable and efficient division of labor.The drill group demonstrated superior accuracy and efficiency in overall organization compared to the conventional group,with its emergen-cy team exhibiting a more effective and rational division of labor.The drill group achieved their expected outcomes in emergency drills,whereas the convention group achieved only part of their set goals,with most requiring enhancement.The drill group re-ported to superiors in a more timely and efficient manner compared to the convention group,and the group showed better coordina-tion between their departments was good,which could be achieved in a timely manner.The drill group demonstrated a significant-ly better overall response to emergencies and significantly stronger emergency awareness compared to the convention group(P＜0.05).Conclusion Scenario-driven unscripted emergency drills can enhance the emergency response capabilities of nursing staff,improve their decision-making and command skills,optimize organizational coordination,and handling abilities,and strengthen their first aid awareness.

Objective To analyze the timeliness of the start time of the first elective operation in a hospital and observe its impact on the operating room cost.Methods Make statistics and analysis on the opening of the first operation in a hospital,record the on-time opening rate of the first operation,analyze the reasons for the delay in the opening time of the first operation,formulate corresponding intervention measures and set up a"management team to improve the efficiency of operating room use".The on-time rate of the first operation,operation,cost control and the satisfaction of surgeons and patients were compared before and after the operation.Results The overall punctuality rate of the first operation was 53.74％,among which the colorectal sur-gery department had the highest punctuality rate of 63.16％,while the minimally invasive surgery department had the lowest punctuality rate of 45.45％.The main reasons for the delay of first operation(35.29％),failed anesthesia(30.88％),and the termination of the operation(17.65％);compared with before implementation,higher overtime time of nurses,shorter opening time and expected time,decreased interval between operation(P＜0.05),lower frequency of centralized delivery and unnecessa-ry consumables cost within 1 month after implementation(P＜0.05),and higher satisfaction of patients and physicians after im-plementation(P＜0.05).Conclusion By improving the first elective operation on time,can effectively reduce the cost of the operating room,shorten the nurse overtime time,at the same time improve the satisfaction of doctors and patients,and improve the management efficiency of the operating room,the first operation on time improved,interval time and unnecessary consumables costs are significantly reduced,optimize the use efficiency of the operating room resources.

Objective:To evaluate the efficacy and safety of hypomethylating agents (HMA) in patients with myelodysplastic syndromes (MDS) .Methods:A total of 409 MDS patients from 45 hospitals in Zhejiang province who received at least four consecutive cycles of HMA monotherapy as initial therapy were enrolled to evaluate the efficacy and safety of HMA. Mann-Whitney U or Chi-square tests were used to compare the differences in the clinical data. Logistic regression and Cox regression were used to analyze the factors affecting efficacy and survival. Kaplan-Meier was used for survival analysis. Results:Patients received HMA treatment for a median of 6 cycles (range, 4-25 cycles) . The complete remission (CR) rate was 33.98% and the overall response rate (ORR) was 77.02%. Multivariate analysis revealed that complex karyotype ( P=0.02, OR=0.39, 95% CI 0.18-0.84) was an independent favorable factor for CR rate. TP53 mutation ( P=0.02, OR=0.22, 95% CI 0.06-0.77) was a predictive factor for a higher ORR. The median OS for the HMA-treated patients was 25.67 (95% CI 21.14-30.19) months. HMA response ( P=0.036, HR=0.47, 95% CI 0.23-0.95) was an independent favorable prognostic factor, whereas complex karyotype ( P=0.024, HR=2.14, 95% CI 1.10-4.15) , leukemia transformation ( P<0.001, HR=2.839, 95% CI 1.64-4.92) , and TP53 mutation ( P=0.012, HR=2.19, 95% CI 1.19-4.07) were independent adverse prognostic factors. There was no significant difference in efficacy and survival between the reduced and standard doses of HMA. The CR rate and ORR of MDS patients treated with decitabine and azacitidine were not significantly different. The median OS of patients treated with decitabine was longer compared with that of patients treated with azacitidine (29.53 months vs 20.17 months, P=0.007) . The incidence of bone marrow suppression and pneumonia in the decitabine group was higher compared with that in the azacitidine group. Conclusion:Continuous and regular use of appropriate doses of hypomethylating agents may benefit MDS patients to the greatest extent if it is tolerated.

A puerpera with a obstetric history of gravida 2, para 2, underwent blood typing due to the presence of agglutination reactions in her serum against all tested red blood cells. She was found to be blood type O and her RhD phenotype was identified as CcDEe through serological testing. The reaction agglutination intensity between her serum and 26 O-type blood cells from the panel was 2+. Whole genome sequencing was performed, yielding data on 4014 single nucleotide polymorphisms (SNPs) and 958 insertion/deletion (INDEL) loci across 50 genes responsible for encoding blood group systems. Among these, only a single SNP , rs72552713 was predicted to be a highly harmful variant, which is the c.376C>T variation in the ABCG2 gene encoding JR blood group antigen, leading to the premature stop codon (p.Gln126Ter). The c.376C>T variation has been named the ABCG2*01N.01 by the working party on Red Cell Immunogenetics and Blood Group Terminology of International Society of Blood Transfusion. The postpartum woman was found to have the Jr(a-) phenotype. Whole genome sequencing can accurately determine the antigens of blood group systems in some difficult specimens.

Objective: This study aimed to translate the English version of the Perceived Competence Scale for Disaster Mental Health Workforce (PCS-DMHW) into Chinese, and to test its reliability and validity in Chinese mental health workers. Methods: With the consent of Professor Choi, Keimyung University, Korea, and the authorization of the scale, the English version of PCS-DMHW was translated, retranslated and culturally debugged to form the Chinese version of PCS-DMHW. The general information questionnaire and the Chinese version of PCS-DMHW scale were used to investigate 706 mental health workforce from 9 tertiary hospitals in Sichuan province in China from March 24, 2020 to April 14, 2020. The Cronbach’s α coefficient was used to evaluate the internal consistency reliability of the scale, and the test-retest correlation coefficient r was used to evaluate the test-retest reliability of the scale. The content validity indexes (CVI) and exploratory factor analysis (EFA) was used separately for evaluating the content validity and structure validity of the scale. Results: The Cronbach’s α coefficient of the Chinese version of PCS-DMHW total scale, individual competences and organizational competences subscale was 0.978, 0.956, and 0.964, respectively. The test-retest reliability of the total scale, individual competences and organizational competences subscale was 0.949, 0.932 and 0.927, respectively. The item-level CVI of all scale were ranged from 0.833–1.000, the scale-level CVI (S-CVI)/universal agreement of the total scale, individual competences and organizational competences subscale was 0.833, 0.875, and 0.857, respectively, and the S-CVI/average was 0.972, 0.979, and 0.976, respectively. EFA showed that two principal components were extracted from the subscale of individual competences and organizational competences. Conclusion The Chinese version of PCS-DMHW has good reliability and validity, and can be widely used in China.

Objective:To explore the effect of narrative medicine course on the empathy ability and comprehensive ability training of residents in the standardized residency training in municipal hospitals.Methods:A narrative medicine group was set up in a municipal hospital, and a anarrative medical course of 2 months of narrative theory teaching and 4 months of clinical practice education was carried out among 42 residents. The Chinese version of the Interpersonal Response Index Scale (IRI-C) was used to measure the empathy ability at 4 time points (before intervention, 2 months after theory education, 2 months after practice, and 4 months after practice). The effect of narrative medicine courses was evaluated through the satisfaction questionnaire survey, parallel medical record writing and the first-time pass rate of Medical Practitioner Qualification Examination. SPSS 25.0 was used to analyze the variance of one-way repeated measurement.Results:The empathy ability of 42 residents was significantly improved. The empathy score after 2 months after practice was higher than that before intervention and after the theoretical course ( P < 0.05), while the empathy score after 4 months of practice was higher than that before intervention and after the theoretical course ( P < 0.05). The most popular theoretical teaching forms among residents were interactive theoretical teaching (64.29%, 27/42), video viewing (59.52%, 25/42), and situational simulation (52.38%, 22/42). The comprehensive abilities of parallel medical record writing and podium performance among residents were improved. Passing the Medical Practitioner Qualification Examination is a necessary condition for passing the residency training program. The first-time pass rate of the Qualification Examination for the residents was 72.00% (18/25), which was higher than that of the residents who were not recruited during the same period (64.71%, 11/17). Conclusion:Carrying out narrative medicine education is helpful to improve the empathy ability and comprehensive ability of training residents in municipal hospitals.

Objective:To evaluate the efficacy and safety of mycophenolate mofetil(MMF) in patients with active moderate to severe thyroid associated ophthalmopathy(TAO) refractory to multiple intravenous glucocorticoid(GC).Methods:Fifty-two patients with active moderate to severe TAO that was refractory to multiple intravenous GC were treated with MMF 0.5g orally, 2/d. To evaluate the overall response rate of TAO patients, the improvement of more than 3 items including clinical disease activity score(CAS), soft tissue involvement, proptosis, diplopia, decrease of eye movements, visual acuity and other improvements were defined as response.Results:After 12 weeks of MMF treatment, the overall response rate of TAO patients was 75.0%, and then increased to 88.5% significantly at the 24th weeks. At the 12th weeks, CAS decreased from(5.06±1.21) to(2.52±1.13), and then continued to decrease to(2.02±0.92) at the 24th week( P<0.05), the response rates were 82.7% and 90.4%, respectively. In addition, after 12 weeks of treatment, 58.1% of patients with diplopia improved significantly, and the response rate was 74.2% at the 24th weeks. Similarly, the degree of proptosis decreased significantly at the 12th and 24th weeks, and the response rates were 53.8% and 69.2%, respectively. No serious adverse events occurred during the treatment. Conclusion:The MMF therapy is efficient and safe for patients with active moderate to severe corticosteroid-resistant TAO.

This study was aimed to investigate the association between dyslipidemia and thyroid associated ophthalmopathy (TAO). We evaluated the relationship between dyslipidemia and TAO in 218 patients with Graves′ disease (GD) and found that the serum total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) in the GD subjects with TAO (n=110) were significantly increased [(5.32±1.39) mmol/L vs. (3.18±2.12) mmol/L, (2.98±0.75) mmol/L vs. (1.25±0.98) mmol/L] than those in the GD subjects without TAO (n=108). TC and LDL-C were positively correlated with the Clinical disease activity score (CAS) [TC (r=0.7, P=0.03),LDL-C (r=0.82, P=0.03)], and the levels of TC (OR=2.56, P=0.02) and LDL-C(OR=2.01, P=0.015) were positively associated with TAO. These suggested that high serum cholesterol level is a novel risk factor for TAO, and management of blood lipids should be included in the treatment of TAO.

Objective To investigate the effect of glutamine (GLN) treatment on neurobehavioral outcome,brain edema and inflammatory response in rats after traumatic brain injury (TBI),and to find out the role played by autophagic response in this effect.Methods Rat models with TBI in this study were established using Feeney's method.One hundred healthy male SD rats were randomly divided into five groups (n =20) to receive sham operation (group Sham),TBI (group TBI),TBI and glutamine treatment (group TBI+GLN),TBI amd autophagy inhibitor 3-methyladenine (group TBI+ 3-MA),and TBI,GLN and autophagy inhibitor (group TBI+GLN+3-MA).We measured the rats' behavioral outcomes by modified neurologic severity score (mNSS) tests at day 1,3,7 and 14 after intervention.Brain water content was measured with wet-dry weight method.The serum levels of tumor necrosis factor-α (TNF-ct),interleukin (IL)-1 and IL-4 were tested using enzyme linked immunosorbent assay.The expressions of autophagy-related factors (LC3-Ⅱ,Beclin-1) in TBI cerebral cortex were tested with Western blot.Results Compared with the Sham group,the other four groups had significantly increased levels of brain edema,mNSS,serum inflammatory factors and cerebral LC3-Ⅱ and Beclin-1 (P=0.00).Compared with the TBI group,the TBI+GLN group had less severe brain edema and improved mNSS,lower levels of TNF-α [(57.71 ±9.69) pg/ml vs.(83.37± 12.81) pg/ml,P=0.01] and IL-1 [(39.46±8.60) pg/ml vs.(69.04± 10.48) pg/ml,P=0.00],higher levels of IL-4 [(68.72± 11.18) pg/ml vs.(35.75 ± 8.40) pg/ml,P =0.04],and upregulated expressions of LC3-Ⅱ and Beclin-1 (P=0.01).Compared with the TBI+GLN group,the TBI+GLN+3-MA group had severer neurofunctional impairment,brain edema and inflammation (P＜ 0.05).Conclusions Treatment with GLN markedly reduced brain edema and improved neurobehavioral outcomes in rats with TBI by inhibiting inflammatory response in the central nervous system.The mechanism might have been the activation of the autophagic response.