Sources of stress and coping strategies among Chinese medical graduate students: a qualitative study.

BACKGROUND: The incidence of mental health problems among medical graduate students is much higher than among students of other disciplines. This can have adverse consequences for the medical students themselves as well as their future patients. This study aims to understand the pressures faced by Chinese medical students and the current status of mental health education. It also propose recommendations for the current situation and prospects for the future. METHOD: The authors conducted in-depth semi-structured interviews with 22 master's students from five medical schools during November 2023. All interview sessions were recorded and transcribed verbatim. The transcriptions were analyzed using the Colaizzi's seven-step method. RESULT: Three main themes were extracted from the students' statements: sources of psychological stress, ways to cope with stress, and perspectives on mental health education. The study showed that current mental health education in China is mostly in the form of printed mental health education manuals and mental health lectures, and there is no active tiered intervention for students at different levels. It is suggested that reforms should be made to shift to a model where the school proactively identifies problems and intervenes based on feedback. CONCLUSION: This study reveals the widespread psychological stress and shortcomings in current education methods. To address these challenges, institutions should develop tailored interventions, including tiered support systems, open dialogue promotion, and resilience training. Future research should focus on evaluating innovative interventions' effectiveness, ultimately fostering a supportive environment that enhances students' success and contributes to a healthier healthcare workforce.

Effect of propofol and sevoflurane on postoperative fatigue after laparoscopic hysterectomy.

BACKGROUND: Postoperative fatigue syndrome (POFS) is an important factor in postoperative recovery. However, the effect of anesthetic drugs on postoperative fatigue in female patients has been rarely studied. This study compared the effects of maintaining general anesthesia with propofol or sevoflurane on the incidence of POFS in patients undergoing laparoscopic hysterectomy. METHODS: This prospective, single-blind, randomized controlled trial enrolled patients scheduled for laparoscopic hysterectomy. Eligible patients were randomized into the propofol and sevoflurane groups. The primary outcome was the incidence of POFS within 30 Days, defined by a simplified identity consequence fatigue scale (ICFS-10) scores≥24 or Visual Analogue Scale (VAS) scores of fatigues>6. Secondary outcomes were perioperative grip strength, early ambulation and anal exhaust after surgery, and inpatient days. RESULTS: 32 participants were assigned to the propofol group (P) and 33 to the sevoflurane group (S). Incidence of POFS on postoperative D1 was P (8/32) vs. S (10/33) (p = 0.66, 95% confidence interval [CI]: 16.4-27.00); D3 P (2/32) vs. S (5/33) (p = 0.45,95% CI:5.96-23.76). POFS were not found on postoperative D5 and D30. There were no differences in perioperative grip strength, early ambulation and anal exhaust after surgery, and inpatient days between the two groups. CONCLUSIONS: POFS after scheduled laparoscopic hysterectomy was unaffected by anesthesia with propofol vs. sevoflurane. The incidence of POFS was highest on the first postoperative day, at 27.7%, and declined progressively over the postoperative 30 days. Trial registration Chinese Clinical Trial Registry (No. ChiCTR 2,000,033,861), registered on 14/06/2020).

Reducing carbon footprints and increasing net ecosystem economic benefits through dense planting with less nitrogen in double-cropping rice systems.

Excessive application of nitrogen fertilization in farmland systems can cause nitrogen wastage, environmental pollution, and increase greenhouse gas (GHG) emissions. Dense planting is one of the efficient strategies for nitrogen fertilizer reduction within rice production. However, there are paying weak attention to the integrative effect of dense planting with less nitrogen (DPLN) on carbon footprint (CF), net ecosystem economic benefit (NEEB) and its components in double-cropping rice systems. Herein, this work aims to elucidate the effect via field experiments in double-cropping rice cultivation region with the treatments set to conventional cultivation (CK), three treatments of DPLN (DR1, 14 % nitrogen reduction and 40,000 hills per ha density increase from CK; DR2, 28 % nitrogen reduction and 80,000 hills density increase; DR3, 42 % nitrogen reduction and 120,000 hills density increase), and one treatment of no nitrogen (N0). Results showed that DPLN significantly reduced average CH4 emissions by 7.56 %-36 %, while increasing annual rice yield by 2.16 %-12.37 % compared to CK. Furthermore, the paddy ecosystem under DPLN served as a carbon sink. Compared with CK, DR3 increased gross primary productivity (GPP) by 16.04 % while decreasing direct GHG emissions by 13.1 %. The highest NEEB was observed in DR3, which was 25.38 % greater than CK and 1.04-fold higher than N0. Therefore, direct GHG emissions and carbon fixation of GPP were key contributors to CF in double-cropping rice systems. Our results verified that optimizing DPLN strategies can effectively increase economic benefits and reduce net GHG emissions. DR3 achieved an optimal synergy between reducing CF and enhancing NEEB in double-cropping rice systems.

[Effects of increased planting density with reduced nitrogen fertilizer application on greenhouse gas emission in double-season rice fields under water saving and simple cultivation mode]. / èŠ‚æ°´è½»ç®€æ ½åŸ¹æ¨¡å¼ä¸‹å¢žå¯†å‡æ°®å¯¹åŒå­£ç¨»ç”°æ¸©å®¤æ°”ä½“æŽ’æ”¾çš„å½±å“.

To clarify the effects of increased density and reduced nitrogen on greenhouse gas emission in double-season paddy fields under the water-saving and simple cultivation mode, we used Luliangyou 996 (early rice) and Fengyuanyou 299 (late rice) as materials to collect greenhouse gas by closed static box method, monitored the dynamics of CH4 and N2O emissions from different combinations of increased density and reduced nitrogen for early and late rice, and explored changes in cumulative CH4 and N2O emissions, global warming potential (GWP) and greenhouse gas intensity (GHGI) as affected by different combinations of increased density and reduced nitrogen from double-season rice fields. The results showed that the cumulative emissions of CH4 and N2O from different combinations were significantly different. Compared with the control (CK), cumulative CH4 emission, GWP and GHGI in the two seasons decreased by 50.8%, 37.3%, and 42.9% for the combination of increased density and reduced nitrogen IR2(the amount of nitrogen applied of early rice was 86.4 kg·hm-2, the density was 360000 holes·hm-2; the amount of nitrogen applied of late rice was 108 kg·hm-2, the density was 320000 holes·hm-2), respectively. IR2 of early rice had the lowest N2O cumulative emission, being 33.7% lower than CK. IR1(the amount of nitrogen applied of early rice was 103.2 kg·hm-2, the density was 320000 holes·hm-2; the amount of nitrogen applied of late rice was 129 kg·hm-2, the density was 280000 holes·hm-2) of late rice had the lowest N2O cumulative emission, being decreased by 94.9%. IR2 had the lowest annual total GWP and GHGI of double-season paddy fields. Compared with other treatments of increased density and reduced nitrogen, the IR2 treatment, where nitrogen fertilizer in both early and late rice was reduced by 28.0%, the density of early rice was increased by 28.6%, and the density of late rice was increased by 33.3%, was an effective and safe option for simultaneously ensuring high yield and reducing greenhouse gas emissions.

Effect of electrically stimulating acupoint, Zusanli (ST 36), on patient's recovery after laparoscopic colorectal cancer resection: a randomized controlled trial.

OBJECTIVE: To investigate the effect of transcutaneous electrical acupoint stimulation (TEAS) on enhanced recovery after surgery (ERAS) in laparoscopic colorectal cancer resection and its clinical significance. METHODS: Sixty-four patients undergoing laparoscopic colorectal resection were randomly divided into two groups, the control group (group A) and the TEAS group (group B). Patients in the TEAS group received electroacupuncture stimulation of bilateral Zusanli (ST 36) at 30 min before anesthesia to the end of surgery. The patients in the control group were not given the stimulation. Perioperative anesthesia management of the two groups were performed according to the ERAS guidelines, and postoperative patient-controlled intravenous analgesia (PCIA) was used. The amount of remifentanil used in the two groups was observed and recorded, and the visual analogue scale (VAS) of the 4, 12, 24 and 48 h after surgery in the two groups was recorded. Moreover, postoperative anal exhaust time, postoperative feeding time, postoperative first ambulation time and postoperative hospital stay length were compared between the two groups. RESULTS: Compared with group A, the VAS score of group B decreased significantly at 48 h after operation (P < 0.05). The postoperative anal exhaust time in group B was significantly shorter than that of group A (P < 0.05). There was no significant difference between the two groups with regards to remifentanil consumption, postoperative feeding time, postoperative first ambulation time and postoperative hospital stay (all P > 0.05). CONCLUSION: TEAS can promote the recovery of postoperative gastrointestinal function and reduce the pain intensity 48 h after surgery, thus satisfying the need of early postoperative analgesia.

[Application of Transcutaneous Electrical Acupoint Stimulation Combined with Transversus Abdominis Plane Block to Enhanced Recovery After Surgery in Patients Undergoing Laparoscopic Colorectal Cancer Resection: A Randomized Controlled Clinical Trial].

OBJECTIVE: To explore the effect of transcutaneous electrical acupoint stimulation (TEAS) combined with transversus abdominis plane (TAP) block in the enhanced recovery after surgery (ERAS) in patients undergoing laparoscopic colorectal cancer resection (LCCR). METHODS: A total of 101 patients undergoing LCCR were randomly divided into three groups: control (n＝34), TAP (n＝35) and TEAS＋TAP (n＝32). Conventional perioperative anesthesia management of the 3 groups was performed according to the ERAS guidelines. All the patients experienced patient controlled epidural analgesia (PCEA), and those of the TAP and TEAS＋TAP groups received TAP block by injection of 0.3% Roperca hydrochloride (15 mL) into the space between the internal oblique and the transverse abdominis after induction of anesthesia. For patients of the TEAS＋TAP group, TEAS (2 Hz/10 Hz, an endurable stimulation strength) was applied to bilateral Zusanli (ST 36) from 30 min before anesthesia to the end of the surgery. The blood glucose value and dosage of Remifentanil used were recorded. The pain severity was assessed at 4, 12, 24 and 48 h after surgery by using visual analogue scale (VAS). Moreover, postoperative anal exhaust time, postoperative oral feeding time, postoperative first ambulation time and postoperative hospital stay length were recorded. RESULTS: The total dosages of Remifentanil used during surgery, and the blood glucose levels were significantly lower in the TAP and TEAS＋TAP groups than in the control group (P<0.05), but had no significant differences between the TAP and TEAS＋TAP groups (P>0.05). The VAS scores of the TAP and TEAS＋TAP groups were considerably lower than those of the control group at 4, 12, 24 and 48 h after surgery (P<0.05, except 48 h of TAP group). Of the 34, 35 and 32 cases in the control, TAP and TEAS＋TAP groups, 5(14.7%), 3(8.6%) and 1(3.1%) on the 1st day post-surgery, and 2(5.9%), 0(0) and 0(0) on the 2nd day after surgery experienced nausea and vomiting. The postoperative anal exhaust time and postoperative oral feeding time were significantly earlier in both TAP and TEAS＋TAP groups than in the control group (P<0.05), and the exhaust time of the TEAS＋TAP group was even earlier than that of the TAP group (P<0.05). No significant differences were found among the 3 groups in the postoperative ambulation time and postoperative hospitalization time (P>0.05). CONCLUSION: TEAS combined with TAP block analgesia is superior to simple TAP block analgesia in relieving postoperative pain, shortening the recovery time of gastrointestinal function and promoting postoperative rehabilitation in patients undergoing LCCR.

[Effects of Water and Nitrogenous Fertilizer Coupling on CH4 and N2O Emission from Double-Season Rice Paddy Field].

To provide support for the efficient use of water and fertilizer technology to double-season rice cultivation, water and fertilizer coupling mode was applied in this research, including two irrigation methods and four N levels. The irrigation methods were flood irrigation and intermittent irrigation, while four N levels were high-N, middle-N, low-N and none-N. Field experiment was conducted to study the effect of water and fertilizer coupling mode on CH4 and N2O emission. The results showed that the accumulated CH4 emissions were significantly reduced by intermittent irrigation, in comparison with flood irrigation, the reduction in early rice season were from 13. 18 kg.hm-2 to 87. 90 kg.hm-2, and were from 74. 48 kg.hm-2 to 131. 07 kg.hm-2 in late rice season, with a rate of 24. 4% -67. 4% and 42. 5% -65. 5% respectively; whereas the accumulated N20 emissions were increased, the increment were from 0. 03 kg.hm-2 to 0. 24 kg.hm-2 in early rice season and from 0. 35 kg.hm-2 to 1. 53 kg.hm-2 in late rice season when compared flood irrigation, increased by 6.2% -18. 3% and 40.2% - 80.9% respectively. On the whole, intermittent irrigation reduces the warming potential of greenhouse gases (GWP), which were decreased by 18. 8% to 58. 6% in early rice season and by 34. 4% to 60. 1% in late rice season, and the reduction of total GWP were from 2 388 to 4 151 kg. hm-2 (CO2 eq), with a rate of 41% -54% . Through correlation analysis it found that CH4 emissions from soil were significantly related with soil solution Eh and solution CH4 concentration. In comparison with the flood irrigation, the application of intermittent irrigation in double-season rice cultivation was conducive to CH4 reduction, though the increase came in N2O, but the GWPs were significantly reduced. Comprehensively, intermittent irrigation matching with middle-N is more benefit to double-season rice cultivation.