Objective To investigate the training needs and suggestions of advanced practice nurses in medical institutions in China,and to provide references for the formulation of training programs for advanced practice nurses.Methods By a convenient sampling method,from May to July in 2023,the heads of nursing nurses in medical institutions in 29 provinces,autonomous regions and municipalities directly under the Central Government were investigated,and the self-designed questionnaires were distributed in the form of electronic questionnaire.Results 1 287 medical institutions participated in the survey,with tertiary hospitals accounting for 65.50％.93.16％of medical institutions had the use needs of advanced practice nurses,and the top 3 professional fields hoping to prioritize in the APN training were in the order of critical illness,emergency treatment and intravenous treatment.Among the APN core competence,the most important one was direct clinical practice(92.77％),followed by professional development(89.43％)and scientific research and evidence-based practice(86.40％).71.72％of medical institutions suggested that the theoretical training time is 4 weeks,combining online and offline training(50.35％),and the clinical practice time should not be less than 12 weeks(97.66％).Theoretical learning course assignment(92.93％),case report(90.83％)and clinical practice reflection diary(88.19％)were the main process evaluation methods,while 1 case study with the completion of the report and defense(87.65％)and 1 evidence-based nursing practice research plan with the completion of a report and defense(77.93％)were the main final evaluation methods.Conclusion Advanced practice nurses are important roles in the process of nursing professional development,and medical institutions in our country have a high demand for the training of advanced practice nurses.It is imperative to carry out the training of advanced practice nurses.The suggestions of medical institutions on the training content and methods focus more on the training of core competence.On this basis,the admission conditions should be clarified,and the training program of advanced practice nurses for China's national conditions should be explored.

Objective:To analyze postoperative adverse reactions in patients with acne scars treated with punch elevation.Methods:Totally, 27 patients with moderate or severe acne scars, who were treated with punch elevation, were collected from the Department of Dermatology, Xijing Hospital, Air Force Medical University from June 2020 to March 2021. The patients received local infiltration anesthesia during the operation, and were cared for with tensile adhesive plaster bandaging, cold compresses, and waterproofing after the operation; telephone and face-to-face follow-up visits were conducted immediately, 3, 7, 14, 21, 30, and 60 days after the operation, and numerical rating scale (NRS) of intraoperative pain, postoperative swelling duration, postoperative erythema duration, and the incidence of post-inflammatory hyperpigmentation were recorded.Results:Among the 27 patients, the severity score of acne scars was 77.76 ± 43.76 points. The intraoperative pain NRS score was 3.75 ± 2.95 points after local infiltration anesthesia, the postoperative swelling lasted 3.42 ± 2.43 days, postoperative erythema lasted 4.74 ± 3.25 weeks, and the duration of postoperative erythema was not significantly correlated with the severity score of acne scars ( r = -0.13, P = 0.449). After the operation, post-inflammatory hyperpigmentation occurred in 2 patients, and no local infections or fulminant acne was observed. The patient satisfaction rate was 100% (27/27) . Conclusion:The main adverse reactions to punch elevation for acne scars were postoperative swelling and erythema, which subsided spontaneously about 1 month after the operation.

Objective:To identify Down syndrome (DS) fetal encephalopathy related genes and signaling pathways via bioinformatics analysis, and to explore their potential mechanisms underlying the occurrence and development of DS neuropathology.Methods:Retrospective study.In December 2021, dataset GSE59630 was downloaded from the gene expression omnibus (GEO), and differentially expressed genes (DEGs) between DS and normal fetal brain tissue were identified by R software.Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis and gene set enrichment analysis (GSEA) were performed on the genes identified.The protein-protein interaction (PPI) network was constructed based on search tool for the retrieval of interacting genes online database and Cytoscape software, and key modules and hub DEGs were identified.Real-time quantitative polymerase chain reaction technique was used to verify the expression of hub genes related to neurodegeneration in brain tissue of 3 pairs of DS and normal fetuses at the gestational age of 22-33 weeks.Results:A total of 225 DEGs were screened out from DS and normal fetal brain tissue, including 18 up-regulated genes and 207 down-regulated genes.GO functional enrichment analysis showed that DEGs were mainly enriched in neurogenesis, neuronal apoptosis, transcriptional regulation, mitochondrial energy metabolism, etc.KEGG pathway enrichment analysis revealed that DEGs were associated with a variety of neurodegenerative diseases.GSEA suggested that apoptosis and inflammatory responses play a vital part in the occurrence of DS neuropathology.Ten hub genes were identified by the PPI network established, and they were mainly related to histone acetylation and transcriptional regulation.According to the tissue verification result, the variations of RAB8A, TBP and TAF6 expression conformed to the microarray data. Conclusions:The key genes and signaling pathways identified by transcriptome analysis of fetal brain tissue facilitate the comprehensive understanding of the molecular mechanism of DS neuropathology.This study provides a novel insight into the clinical diagnosis and treatment of neurodevelopmental abnormalities and mental retardation in DS.

Hemophilic arthropathy is the most common complication of hemophilia and is also the main factor of disability in hemophilia patients. Using high-resolution musculoskeletal ultrasound examination technology, the joints of hemophilia patients can be rapidly evaluated and injury grade can be established, which can provide the basis and guidance for clinical evaluation, treatment and prognosis. Standardized ultrasound operation and scoring are very important for objective evaluation of joint condition. This paper introduces the ultrasonic examination and scoring method of hemophilic arthropathy which is suitable for the clinical needs of China in detail in order to improve the consistency of ultrasonic evaluation of hemophilia centers.

Objective:To explore the real experience of the head nurses of the department in the practice of standardized training for new nurses, so as to provide a reference for further forming a scientific standardized training program for new nurses.Methods:From July to August 2020, convenience sampling was used to select 18 head nurses from different clinical departments of 9 large ClassⅢ Grade A hospitals were selected as the research subject for a semi-structured interview. Data were analyzed using the Colaizzi 7-step method.Results:A total of 3 themes were extracted, namely scientific teaching practice, active management practice, and problems and prospects.Conclusions:The head nurses of the department has carried out scientific teaching practice and active management practice in clinical work to ensure the effect of standardized training for new nurses. It is still necessary to further optimize the rotation program with specialties, improve the comprehensive ability of clinical teaching nurses, and strengthen the training of new nurses' critical thinking ability, so as to improve the training effect.

Objective:To investigate the neural mechanism of long-term exposure to high altitudes environment on the processing stage of perceptual closure.Methods:A cross-sectional study was conducted. Thirty college students who first entered the plateau area (at an altitude of 3 658 m) and had lived in high-altitude areas for two years were selected as high altitude group (HA group), and 29 college students matched in age, gender and education level who had never been to the plateau area were selected as sea level group (SL group). The differences of basic physiological parameters were compared between the two groups.The face pairwise comparison paradigm was applied in the subjects of the two groups and the differences between the two groups were compared by event-related potentials (ERPs) technology. SPSS 22.0 software was used for statistical analysis, and the mean ± standard deviation was used for statistical description. Independent sample t test was used for comparison of physiological data between the two groups, and repeated measurement variance analysis was used for ERP data. Results:The physiological results revealed that the HA group had a higher pulse rate((86.71±10.82)/min, (75.97±11.28)/min ; t=-3.19, P=0.002) and diastolic blood pressure than the SL group ((75.93±9.19)mmHg, ( 68.59±11.42) mmHg ; t=-3.20, P=0.002). The oxygen saturation level was significantly lower than that of SL group ((90.77±2.25)%, (98.31±1.56) %) ; t=14.00, P<0.001). In the face pairwise comparison paradigm test, the main effect of P1 latency of ERP was significant.Compared with SL group, HA group showed significantly shortened latency of P1 ((105.10±15.59) ms, (128.35±14.40)ms, P<0.001). The main effect of group of N170 amplitude was significant, HA group was larger than that of SL group((-7.57±3.83) μV, ( -5.11±3.26) μV, P=0.005). The interaction effect between group and hemisphere of NCL amplitude was significant ( F(1, 57)=9.72, P=0.003). Simple effect test showed that the amplitude on the right hemisphere of SL group was significantly larger than that on the left hemisphere((0.46±1.31) μV), (1.16±1.33) μV ). The latency of P1 was significantly correlated with heart rate( r=-0.46, P<0.01), oxygen saturation level( r=0.64, P<0.01) and diastolic blood pressure( r=-0.26, P=0.049). Conclusion:After long-term exposure to high altitude, the neural response related to early visual perception is faster. More psychological resources are recruited during the face structural encoding stage. Contra-lateral compensating effect appeares in the stage of perceptual closure.

Objective:To investigate the value of α-synuclein (α-syn) concentration in cerebrospinal fluid (CSF) in predicting postoperative delirium (POD).Methods:One thousand patients underwent elective surgery with combined epidural-spinal anesthesia in our hospital from January 2018 to September 2020 were selected.The epidural puncture was performed at L 3, 4 interspace, and 2 ml of CSF was collected after the needle reaching the subarachnoid space.The concentrations of α-syn, β-amyloid (Aβ)40, Aβ42, total tau protein (T-tau), and phosphorylated tau protein (P-tau) in CSF were determined by enzyme-linked immunosorbent assay.The concentrations of α-syn in CSF and occurrence of POD in patients of different ages were recorded.Patients were divided into POD group and non-POD group according to whether POD occurred, and frequency matching (1∶1) was performed based on five matching variables of age, ASA physical status, education level, duration of operation, and intraoperative blood loss. Results:Eight hundred and forty-one patients were finally included in the study, and the incidence of POD was 15.0%. There were 126 cases in POD group and 126 cases in non-POD group after matching. The concentrations of α-syn in CSF and incidence of POD were gradually increased with age ( P<0.05). Compared with non-POD group, the concentrations of α-syn, T-tau and P-tau in CSF were significantly increased, the concentrations of Aβ40 and Aβ42 were decreased, Aβ40/P-tau, Aβ42/P-tau, Aβ42/Aβ40 and P-tau/T-tau were decreased in POD group ( P<0.05). After confounding factors were corrected by logistic regression analysis, increased concentrations of α-syn, p-tau, and T-tau in CSF were risk factors for POD ( P<0.05). Increased concentrations of Aβ40 and Aβ42 in CSF and increased Aβ40/P-tau and Aβ42/P-tau were protective factors for POD ( P<0.05). Multiple linear regression analysis showed that the concentration of α-syn in CSF was negatively correlated with Aβ40 and Aβ42 concentrations and positively correlated with P-tau and T-tau concentrations ( P<0.05). The area under the receiver operating characteristic curve of concentrations of α-syn in CSF predicting POD was 0.895, Youden index was 0.664, sensitivity was 80.00%, and specificity was 86.36% ( P<0.001). Conclusion:The concentration of α-syn in CSF is related to the occurrence of POD, and it provides higher accuracy in predicting POD.

Objective:To establish the risk prediction models for postoperative delirium (POD) in elderly patients undergoing non-cardiac surgery and to evaluate the predictive efficacy.Methods:A total of 685 patients of both sexes, aged 65-90 yr, of American Society of Anesthesiologists (ASA) physical status Ⅰ-Ⅳ, who underwent non-cardiac elective surgery requiring tracheal intubation during general anesthesia in general surgery, orthopedics, urology, hepatobiliary and pancreatic surgery in our hospital from January 2020 to December 2020, were selected.Patients were assigned to the training set and validation set at a ratio of 7∶3 using a simple random sampling method.The clinical data of patients in the perioperative period were collected, and the patients were followed up within 1-7 days after operation (or before discharge), and the occurrence of POD was recorded.Univariate and multivariate logistic regression analysis was used to identify the independent risk factors for POD.The risk prediction model for POD was established based on the results of multivariate logistic regression analysis of the training set, a nomogram and receiver operating characteristic (ROC) curve were drawn, and the area under the curve (AUC) was calculated.The validation set was used to verify the prediction model and assess the efficacy of the risk prediction model for POD.Results:A total of 653 patients were enrolled in this study, 139 patients developed POD, and the incidence was 21.3%.The results of multivariate logistic regression analysis showed that advanced age, high ASA physical status classification, low preoperative Mini-Mental State Examination score, complication with diabetes mellitus, low years of education, high preoperative Pittsburgh Sleep Quality Index scale score, long anesthesia time and high numerical rating scale score after operation were independent risk factors for POD in elderly patients undergoing non-cardiac surgery.The risk prediction model for POD was established based on the independent risk factors mentioned above.The AUC of the training set was 0.981, the Youden index was 0.881, the sensitivity was 95.95%, and the specificity was 92.92%; the AUC of the validation set was 0.939, the Youden index was 0.795, the sensitivity was 94.44%, and the specificity was 85.09%.Conclusion:The risk prediction model for POD established based on age, ASA physical status classification, history of diabetes melittus, years of education, preoperative Mini-Mental State Examination score, preoperative Pittsburgh sleep quality index scale score, anesthesia time and postoperative numerical rating scale score has good predictive efficacy in elderly patients undergoing non-cardiac surgery.

Objective:To survey the awareness of common primary care clinical guidelines among primary care providers in Qingdao city.Methods:A questionnaire survey on the awareness of common clinical guidelines in primary care was conducted in August 2020 among 659 providers (293 males and 366 females) from 81 primary medical institutions in Qingdao city. The contents of the questionnaire included the general information of primary physicians, the frequency of using the guidelines, the level of understanding of the guidelines, the effect of guidelines in clinical work, the attitudes towards promoting the guidelines, and the interest in learning the guidelines and the way of learning.Results:A total of 659 valid questionnaires were recovered with a recovery rate of 100.0%. The results showed that 14.7% (97/659) practitioners applied the guidelines in most cases, and 31.6% (208/659) frequently used. There were significant differences in use frequency among providers with different practice types, professional titles, education background, practice locations and institutions ( P<0.01). Among participants, 15.2% (100/659) did not know about primary care guidelines, 63.3% (417/659) knew but did not learned guidelines, 21.5% (142/659) knew and studied guidelines carefully. The top five of the learned guidelines (114, 80.3%) were bronchial asthma (113, 79.6%), type 2 diabetes (108, 76.1%), chronic obstructive pulmonary disease (101, 71.1%), and chronic cor pulmonale (83, 58.5%). Most participants who learnt the guidelines viewed the guidelines as quite helpful or very helpful, the score of usefulness for professional knowledge was the highest (4.44±0.60). Most of participants (94.2%, 621/659) thought it was necessary to develop primary care guidelines; and the major factors affecting the promotion were lack of training (79.8%, 526/659), difficulties in access (46.7%, 308/659) and ignorance or neglect (23.2%, 153/659).Most practitioners (93.8%, 618/659) were interested in learning primary care clinical guidelines, and the expected ways of training were online teaching (70.0%, 420/618), training courses(58.3%, 360/618) and special lectures (55.2%, 341/618). Conclusion:The current situation of learning clinical guidelines among primary care providers in Qingdao is not satisfactory, but they are willing to learn the guidelines for improving clinical practice. We should strengthen the training and promotion of primary care guidelines among primary care providers in the future.

Objective:To establish and implement the training program of male nurses in general hospitals, and to explore the influence of the program on the professional identity and career development of male nurses.Methods:Male nurses in Peking Union Medical College Hospital were selected as the participants in October of 2019, and the training program consisting of management support, professional training, cultural construction and other contents was adopted to conduct intervention. Professional identity and career development were compared and analyzed before and after the intervention.Results:The total score of professional identity level of male nurses after intervention was (121.66±19.91) points, which was significantly higher than that before intervention (117.68±19.05), and the differences in all dimensions were statistically significant ( t value was 6.278, P<0.01). The score of successful in career after intervention (42.30±8.06) was significantly higher than that before intervention (41.81±8.00), and the differences in all dimensions were statistically significant ( t value was 3.928, P<0.01). Conclusion:The implementation of male nurse training program and scientific management of male nurses in general hospitals can effectively improve their professional identity level and promote their career development.