The pathogenesis of chronic wound healing is complex. It is often difficult to heal due to a long course of disease， difficulty in treatment， and it seriously affects the quality of life in patients. The active ingredients， couplet medicinals， and compound formulas of traditional Chinese medicine （TCM） possess unique advantages in the treatment of chronic wound healing. The phosphatidylinositol 3-kinase/protein kinase B （PI3K/Akt） signaling pathway is extremely critical in the treatment of chronic wound healing by regulating a series of biological processes， including cell apoptosis， angiogenesis， and inflammatory responses. This article reviews the relevant research on the regulation of the PI3K/Akt signaling pathway by TCM to promote chronic wound healing. It has been found that the active ingredients of TCM （such as geniposide， astragaloside， and ginsenosides， etc.）， and compound formulas （such as Chonghe ointment， Huanglian ointment， Shirun shaoshang ointment， etc.） mainly reduce inflammatory responses， promote angiogenesis， regulate cell autophagy， and accelerate wound healing by activating the PI3K/Akt signaling pathway； at the same time， there are also a few couplet medicinals（ such as Huangqi-Honghua） and compound formulas （such as Xiangpi Shengji ointment） that exert anti-inflammatory effects by inhibiting this signaling pathway， to promote wound healing.

Objective:To gain a deeper understanding of the comorbidity status of elderly patients with coronary heart disease and the effect of comorbidity on their hospitalization costs.Methods:Using the convenient sampling method, a total of 8 334 elderly hospitalized patients diagnosed with coronary heart disease in Beijing Hospital from January 2018 to December 2021 were selected as the research objects. General Inforamtion Questionnaire and Charson comorbidity index (CCI) were used to investigate the comorbidity of patients.Results:Among the 8 334 elderly patients with coronary heart disease included, 88.18% (7 349/8 334) had comorbidity, and there was a statistically significant difference in hospital costs among patients with different CCI scores ( P<0.01). Elderly patients with coronary heart disease with comorbidity had higher hospital costs. The results of the binomial logistic regression analysis showed that comorbidities increased the hospitalization costs of elderly coronary heart disease patients in both the unadjusted model and the gradually adjusted model for age, gender, occupation, education level, admission department, admission status, admission year, admission mode length of stay and disease classification ( P<0.05) . Conclusions:The comorbidity in elderly patients with coronary heart disease is serious, which is an important factor affecting hospitalization costs. In medical practice, it is necessary to strengthen the comprehensive management of elderly patients with coronary heart disease, pay attention to the influencing factors of hospitalization costs, optimize prevention and treatment strategies, control the occurrence and progression of comorbidities among patients, deepen the reform of medical insurance payment methods such as grouping payments based on disease diagnosis, so as to accurately reduce hospitalization costs and promote the sustainable and healthy development of the medical and health system.

Objective:To investigate the construction of ostomy nurse-led clinics in tertiary hospitals in China.Methods:Using the convenient method, managers of ostomy nurse-led clinics in tertiary hospitals in 31 provinces, autonomous regions and municipalities in China in August 2020 were selected as the survey objects. Questionnaire for Survey on Status Quo of Ostomy nurse-led clinics in ClassⅢ Grade A hospital in China was used to investigate. A total of 367 questionnaires were recovered in this survey, 313 valid questionnaires were recovered, and the effective recovery rate was 85.29%.Results:A total of 313 tertiary hospitals have set up ostomy nurse-led clinics. Among the ostomy nurse-led clinics, 86.58% (271/313) of the ostomy specialist nursing outpatient visits were independent visits by nurses. The opening period of stoma clinic was (6.27±4.08) years and the weekly opening time was (5.30±3.93) half-days. The average monthly outpatient number was 100, with a minimum of 4 and a maximum of 3 000. In terms of job management, 50.48% (158/313) of the stoma specialist nursing outpatient jobs were part-time, managers were mostly undergraduates (74.44%, 233/313) , the professional title of managers was mostly nurse in charge (48.24%, 151/313) , 38.98% (122/313) of hospitals had promotion system and 36.74% (115/313) of hospitals had performance management system. There were large differences in environmental layout, facilities and equipment, goods management and specialist management and there was no unified standard.Conclusions:There are great differences in the construction of ostomy nurse-led clinics in tertiary hospitals in China, which need to be further standardized and unified. It is suggested that relevant departments should introduce relevant policies to encourage the establishment of full-time nurse posts in ostomy nurse-led clinics, guarantee the training, promotion and performance reward of visiting nurses and fully encourage the subjective initiative of ostomy specialist nurses to promote their career development.

Objective:To establish a nomogram prediction model for the prognosis of patients with septic cardiomyopathy (SCM) based on afterload-corrected cardiac performance (ACP), in order to identify septic patients with poor outcomes and treatment.Methods:The data of patients admitted to the department of critical medicine of the Second Affiliated Hospital of Guangzhou Medical University from June 2016 to June 2019 were analyzed. All patients were monitored by pulse indication continuous cardiac output (PiCCO) monitor more than 24 hours and diagnosed as SCM with ACP less than 80%. The predictors of 30-day death risk of SCM patients were screened by univariate Cox regression analysis. Multivariate Cox regression analysis was used to establish the prediction model for 30-day death risk of SCM patients, which was displayed by the nomogram. Finally, the discrimination and calibration of the model were analyzed by receiver operator characteristic curve (ROC curve) and consistency index (C-index).Results:A total of 102 patients with SCM were included and the 30-day mortality was 60.8% (62 cases). Among 102 patients with SCM, 57 patients (55.9%) had mild impairment of cardiac function (60%≤ACP < 80%), and the 30-day mortality was 43.9% (25/57); 39 patients (38.2%) had moderate impairment of cardiac function (40%≤ACP < 60%), and the 30-day mortality was 79.5% (31/39); 6 patients (5.9%) had severe impairment of cardiac function (ACP < 40%), and the 30-day mortality was 100% (6/6). There was significantly difference in mortality among the three groups (χ 2 = 24.156, P < 0.001). The potential risk factors for 30-day death of SCM patients screened by univariate Cox regression analysis were included in multivariate Cox regression analysis. The results showed that the independent risk factors for 30-day death of SCM patients were acute physiology and chronic health evaluation Ⅱ [APACHEⅡ, risk ratio ( HR) = 1.031, 95% confidence interval (95% CI) was 1.002-1.061, P = 0.039], vasoactive inotropic score (VIS, HR = 1.003, 95% CI was 1.001-1.005, P = 0.012), continuous renal replacement therapy (CRRT; HR = 2.106, 95% CI was 1.089-4.072, P = 0.027), and ACP ( HR = 0.952, 95% CI was 0.928-0.977, P < 0.001). The nomogram model was established based on the above independent risk factors and age, and the area under the curve (AUC) was 0.865 (95% CI was 0.795-0.935), P < 0.001; C-index was 0.797 (95% CI was 0.747-0.847), P > 0.05. Conclusions:The nomogram model based on age, APACHEⅡ score, VIS score, CRRT and ACP has a certain clinical reference significance for the prediction of 30-day mortality of SCM patients. The discrimination and calibration are good, however, further verification is needed.

Objective:To explore design of an intelligent teaching platform based on the training path of medical education and its application in clinical nursing teaching and management.Methods:Starting from three stages of medical education in colleges and universities, post-graduation education, continuing education and teacher development and training, combining the whole process of nursing teaching, relying on the nursing management information platform, the intelligent nursing teaching platform was designed and developed by using the front and rear separation design framework and the whole station HTTPS encrypted connection. The platform included teaching plans, teaching training, exam management, teaching feedback, teaching resources and system management modules. Among them, the teaching training module was divided into six sub-modules, such as college education, post-graduation education, continuing education, teacher development, advanced training and base training. The intelligent teaching platform was applied to clinical nursing teaching and management.Results:The use of the platform improved the quality of nursing teaching, provided independent learning environment for nurses and helped the hospital save time and labor costs.Conclusions:The application of intelligent nursing teaching platform effectively saves nursing labor cost and teaching management cost and promotes the development of nursing teaching training assessment and management towards the direction of informatization, which is a training management platform worthy of wide application by nursing teaching managers.

Objective:To evaluate the readiness for application of the Facilitating Client Centred Learning guideline among nurses in a general hospital and analyze its influencing factors. Methods:In December 2019, cluster sampling was used to select 138 nurses from 12 nursing units in a general hospital who intended to apply the guideline as research subjects. The Clinic Readiness of Evidence-Based Nursing Assessment (CREBNA) was used to evaluate the readiness of the guideline application, and the influencing factors were investigated and analyzed through the self-designed Influencing Factors Questionnaire. A total of 138 questionnaires were retrieved and 138 valid questionnaires were collected, with an effective rate of 100%.Results:Among 138 nurses, the score of CREBNA was (134.17±15.57) . The scores of the evidence subscale, organization environment subscale and promotion factor subscale were (51.35±6.22) , (39.85±5.00) and (42.97±5.88) respectively. Univariate analysis showed that the differences in the total score of CREBNA of nurses with different initial qualifications and whether they received evidence-based practice training were statistically significant ( P<0.05) . Multiple linear regression analysis showed that the influencing factors of nurses' readiness for evidence-based practice included the initial qualifications and whether they received evidence-based practice training with statistical differences ( P<0.05) . Conclusions:Nurses' readiness for evidence-based practice is affected by their initial qualifications and whether they have received evidence-based practice training. It is recommended that managers applying the guideline create an organizational environment that supports evidence-based practice, strengthen leadership in evidence-based practice, develop training programs suitable for different groups and various forms, and improve the knowledge, beliefs and skills of evidence-based practice for head nurses, guidance nurses and general nurses to lay a solid foundation for the smooth application of the guideline.

Objective To retrieve and evaluate the evidences for fall prevention in elderly inpatients, and to summary the best evidence. MethodsGuidelines, evidence summaries and systematic reviews related to fall prevention of elderly patients were retrieved in guideline websites and databases by computer from building database to 31st December 2018. Literatures' quality evaluation and evidence grading were carried out with the Chinese version of appraisal of guidelines for research and evaluationⅡ (AGREEⅡ), "2016 Joanna Briggs Institute quality assessment tool on validity evaluation of systematic reviews" and "2014 Joanna Briggs Institute quality level of evidence and grade of recommendation system". ResultsA total of 6 documents were included with 3 guidelines and 3 systematic reviews. Based on evaluation and results extracted, 14 items of the best evidences on fall prevention were summarized in two parts including assessment and prevention, and in 6 aspects involving the medication, facility, environment, functional training, informational support and multifactorial intervention. ConclusionsMedical staff should guide patients to take standardized fall preventive measures to guarantee the safety of patients based on evidence-based medicine.

Objective To carry out quality assessment and content analysis on guidelines on arteriovenous fistula (AVF) dysfunction monitoring in hemodialysis patients so as to provide a reference for building the localized clinical practice plan. MethodsDocuments were retrieved in guideline websites, professional society websites and electronic databases at home and abroad by computer. Quality assessment was carried out with the appraisal of guidelines for research and AGREEⅡ and JBI quality assessment tool on consensuses, and the recommendations of included guidelines were summarized. ResultsTotals of 4 evidence-based guidelines and one consensus were included with three of them in the level A and one in the level B of overall quality evaluation. A total of 12 items in 7 aspects were extracted including policy-making, team building, monitoring technology, training of personnel, continuous quality improvement, risk assessment and health education. Intraclass correlation coefficients of 4 evidence-based guidelines ranged from 0.866 to 0.935. Conclusions The guidelines have high levels of overall quality, but applicability needs to be improved. The recommendations are in general accord with each other, which can provide a basis for building the localized clinical practice plan.

Objective: To evaluate the effect of computer-assisted design based on three-dimensional reconstruction technique on the reduction accuracy of tibial and fibular fractures with Taylor external fixation. Methods: A retrospective review was conducted on the clinical data of 69 patients who had tibia and fibula fractures treated with Taylor external fixation in department of orthopedic trauma of Tianjin Hospital from January 2016 to January 2018 to compare the residual deformity after fracture reduction between computer-assisted design method (experimental group) and the standard measurement method (control group). The frontal and lateral tibia and fibula X-ray of all the affected limbs were taken. In experimental group, all the patients took bilateral tibial CT tomography, and then DICOM format documents were input into the Mimics 17.1 software and got three-dimensional models of targeted bone and external fixation ring. After that the visual image matching was performed between external fixation ring three-dimensional reconstruction model and the standard model and also between the affected limb and the contralateral limb. Then the reduction trajectory plan of bone broken end and the position of external fixation ring were obtained. The STL files were input to Solid Works software and got the length of six rods to adjust the Taylor external fixation. In control group, the films were measured by Coreldraw X7 X-ray measurement software and the parameters were input in Taylor Spatial Frame system software. And then six calibrated threaded rods were adjusted according to the prescription of the software. Finally, all the patients took the X-ray films again to evaluate the degree of residual displacement. Skew distributional data are indicated with M(Q_R), and method of non-parameter was used to analyze variances between groups. Results: All patients had better fracture reduction and achieved functional reset criteria. In the control group, the amount of displacement and angle residual aberration (improvement) in the frontal and lateral radiographs were 0.50(2.30)mm(90%), 0.00(0.85)mm(100%)and 0.00°(1.50°)(100%), 0.00°(0.00°)(100%), respectively. In the control group, the amount of displacement and angle residual aberration (improvement) in the frontal and lateral radiographs were 1.40(3.28)mm(69%), 2.15(4.27)mm(46%)and 1.15°(1.85°)(73%), 0.80°(2.10°)(67%). The positive and lateral angles and lateral displacements in the two groups were significantly different(P<0.05), but there was no statistically significant difference in positive displacement (P=0.099). Conclusion Both computer-assisted design method and the standard measurement method have satisfactory reduction effect, but computer-assisted design can accurately correct fracture deformity, which is good for fracture healing and functional recovery of affected limb.

Objective To explore radiographic and MRI features of the hemangiomas and vascular malformation in the deep soft-tissue of the extremities.Methods 89 cases confirmed by surgical pathology and angiography were analyzed retrospectively with clinical data and radiological findings.Imaging exams included plain X-ray performed in all patients,and MRI scan in 33 patients.Results On X-ray plain film,there was normal bone and soft tissue in 54 cases(60.7%),soft tissue abnormalities in 14 cases(1 5.7%),and phleboliths in 30 cases(33.7%).Also,plain X-ray film studies demonstrated bone changes adjacent to the deep soft tissue in 32 cases(36.0%), including periosteal reactions(13 cases),cortical erosion (1 6 cases),involvement of the bone marrow (10 cases)and 7 diffuse lesions with all above changes.On MRI,lesions were similar to honeycomb or sponge,and T1 WI showed isohypointense signal in 25 cases (75.8%),hypointense in 5 cases (1 5.2%),inhomogeneous slightly hyperintense in 3 cases (9.0%).On T2 WI,all lesions were well defined and showed hyperintense signals with hypointense septation,of which there were 9 cases with nodular hypointense areas and vascular flow effect.Hypointense phleboliths were showed in 10 cases(30.3%).Following injection of the contrast medium,all lesions had heterogeneous enhancement patterns.Of the 33 patients studies with MRI,lesions of 18 cases(54.5%)had bone changes which were adjacent to or partially or fully wrapped by neighbouring soft tissue lesions,in which lesions of 12 cases showed abnormal signal within bone marrow and lesions of 3 cases with vascular flow void phenomenon.In 15 cases (45.5%)without osseous change,lesions of 3 cases were adjacent to bone,and lesions of 12 cases were with fat and muscle septum between the bone and lesions.Conclusion The hemangiomas and vascular malformation in the deep soft-tissue of the extremities may cause changes in adjacent bones.Familiarity with the performance of reactive bone changes on X-ray and MRI may help to improve the diagnosis and avoid misdiagnosis.