The implantation of left ventricular assist device (LVAD) has significantly improved the quality of life for patients with end-stage heart failure. However, it is associated with the risk of complications, with unplanned readmissions gaining increasing attention. This article reviews the influencing factors, prediction methods and models, and intervention measures for unplanned readmissions in LVAD patients, aiming to provide scientific guidance for clinical practice, assist healthcare professionals in accurately assessing patients' conditions, and develop rational care plans.

Crigler-Najjar syndrome (CNS) and Gilbert syndrome (GS; OMIM: 143500) are rare autosomal recessive diseases that cause unconjugated hyperbilirubinemia due to decreased UGT1A1 enzyme activity. Crigler-Najjar syndrome type 2 (CNS2; OMIM: 606785) increases the risk of gallbladder stone formation and cholecystitis, while GS seldom causes health issues. We found a 28-year-old male patient with recurring right upper abdomen pain who experienced persistent jaundice from birth. CNS2 with gallbladder stones and cholecystitis was diagnosed after genetic testing revealed rare double homozygous mutations A(TA)₇TAA (rs3064744) and P229Q (rs35350960) in the UGT1A1 gene. After pedigree investigation, we found that the patient's parents with modestly increased bilirubin had compound heterozygous mutations A(TA)₇TAA and P229Q, which were GS. Bioinformatics analysis showed that A(TA)₇TAA is in the TATA-box region of the gene UGT1A1 promoter, affecting gene transcriptional initiation, whereas P229Q modifies protein three-dimensional structure and may be harmful. In this pedigree, double homozygous mutations have a more severe phenotype than compound heterozygous mutations. Inherited causes of hyperbilirubinemia should be suspected after ruling out biliary obstruction, and early bilirubin reduction (< 103 µmol/L (6 mg/dL)) may reduce the risk of complications like cholecystitis in CNS2 patients, though further studies with longer follow-up are needed to confirm this observation.
Humans ; Male ; Glucuronosyltransferase/genetics* ; Adult ; Crigler-Najjar Syndrome/complications* ; Cholecystitis/etiology* ; Homozygote ; Mutation ; Pedigree

Objective To observe the value of MRI texture features combined with apparent diffusion coefficient(ADC)for differentiating uterine sarcoma(US)and cellular uterine leiomyoma(CUL).Methods Pelvic MRI data of 27 US patients(US group)and 34 CUL patients(CUL group)were retrospectively analyzed.The texture features of lesions were extracted from T2WI and diffusion weighted imaging(DWI),the ADC value were measured,and the average ADC value(ADCmean),the minimum ADC value(ADCmin)and standard ADC value(ADCst)were recorded.Then logistic regression(LR)models were constructed based on ADC value,optimal texture features alone and their combination,respectively,including LRADC,LRtexture and LRADC+texture models.Receiver operating characteristic curves were drawn,and the area under the curves(AUC)were calculated to evaluate the efficacy of each model for differentiating US and CUL.Results The ADCmean,ADCmin and ADCst in US group were all lower than those in CUL group(all P＜0.05).A total of 3 750 texture features were extracted from pelvic T2WI and DWI,5 optimal features were finally obtained,and the constructed LRADC+texture model and LRtexture model had similar efficacy of differentiating US and CUL(AUC=0.921,0.887;P＞0.05),which were both higher than that of LRADC model(AUC=0.696;both P＜0.05).The calibration curve of LRADC+texture model was basically consistent with the ideal curve,which had better clinical benefits than LRADC and LRtexture models.Conclusion MRI texture features combined with ADC value could improve efficacy for differentiating US and CUL.

Objective:To understand the status and coping strategies of death anxiety among military nurses participating in emergency public health incident response, and to provide references for improving their coping abilities.Methods:A purposive sampling and snowball sampling method were used to select 15 nurses from multiple military hospitals who supported the emergency public health incident. One-on-one semi-structured interviews were conducted, and the Colaizzi's seven-step analysis method was used to analyze the interview data.Results:Four themes were identified: the occurrence of death anxiety at different time points; the presence of significant outbreaks of death anxiety; multiple factors that help military nurses alleviate death anxiety; and the intrinsic motivation and gains of military nurses participating in the response.Conclusions:It is crucial to monitor the occurrence and changes in death anxiety among nurses throughout the entire cycle of emergency public health incidents. Managers should focus on value guidance, leverage individual positive strengths to cope with death anxiety, enhance information and social support, reinforce training on infectious disease prevention and death education, and reduce the level of death anxiety among military nurses and improve their coping abilities.

Objective:To explore the status and influencing factors of stigma in patients with pituitary adenoma.Methods:From January 2020 to May 2021, a total of 106 patients with pituitary adenoma in the Affiliated Huai'an No.1 People 's Hospital of Nanjing Medical University were selected using the convenience sampling method. Internalized Stigma of Mental Illness, Medical Coping Style Questionnaire and Connor-Davidson Resilience Scale were used to investigate them. Binary Logistic regression analysis was used to evaluate the influencing factors of stigma in patients with pituitary adenoma. Results:Among 106 patients with pituitary adenoma, 87 (82.08%) had stigma. The stigma score of patients with pituitary adenoma was (2.58±0.61) . Binary Logistic regression analysis results showed that family monthly income, coping style and mental elasticity were the influencing factors of stigma in patients with pituitary adenoma ( P<0.05) . Conclusions:Stigma is common in patients with pituitary adenoma. Medical staff should take targeted intervention measures according to the influencing factors of stigma in patients with pituitary adenoma, so as to help patients reduce stigma.

Objective:To investigate the feasibility and value of dual energy CT enterography (DECTE) in evaluating the activity of Crohn′s disease (CD) .Methods:The clinical manifestations, endoscopy and imaging data of 29 patients with CD confirmed by clinic and pathology were analyzed retrospectively. All the patients underwent DECTE scan. The clinical CD activity index (CDAI) was used as the disease activity grouping standard, and 29 cases were divided into 18 cases in active group (CDAI≥150) with a total of 36 intestinal segments, and 11 cases in remission group (CDAI<150) with a total of 20 intestinal segments. The differences in virtual single energy CT value, energy spectrum curve slope and iodine content were analyzed statistically. The diagnostic value of DECTE was evaluated by using receiver operating characteristic (ROC) analysis.Results:The virtual single energy CT value (except the virtual single energy CT value of 90 and 100 keV in portal phase) , curve slope and iodine content in the active group were higher than those in the remission group, and the differences were all statistically significant (all P<0.05) . The diagnostic value in the active phase was higher than that in the remission phase (AUC>0.5) . The AUC of virtual single energy CT was the largest at 60 keV in arterial phase (0.924) , and the specificity of diagnosing CD intestinal segment in active phase was high (95%) , but the sensitivity was slightly poor (75%) . The AUC of the curve slope was the largest in the portal phase (0.731) , and the specificity of diagnosing CD intestinal segment in the active phase was high (85%) , but the sensitivity was low (58.3%) . The AUC of iodine content was the highest in arterial phase (0.885) , and the specificity of diagnosing CD intestinal segment in active phase was high (100%) , but the sensitivity was slightly poor (61.1%) . Conclusion:The virtual single energy CT value, energy spectrum curve slope and iodine content have good diagnostic value, good sensitivity and specificity in the evaluation of CD activity, which can provide reference for clinical accurate diagnosis of CD activity.

Objective:To investigate the feasibility and value of dual energy CT enterography (DECTE) in evaluating the activity of Crohn′s disease (CD) .Methods:The clinical manifestations, endoscopy and imaging data of 29 patients with CD confirmed by clinic and pathology were analyzed retrospectively. All the patients underwent DECTE scan. The clinical CD activity index (CDAI) was used as the disease activity grouping standard, and 29 cases were divided into 18 cases in active group (CDAI≥150) with a total of 36 intestinal segments, and 11 cases in remission group (CDAI<150) with a total of 20 intestinal segments. The differences in virtual single energy CT value, energy spectrum curve slope and iodine content were analyzed statistically. The diagnostic value of DECTE was evaluated by using receiver operating characteristic (ROC) analysis.Results:The virtual single energy CT value (except the virtual single energy CT value of 90 and 100 keV in portal phase) , curve slope and iodine content in the active group were higher than those in the remission group, and the differences were all statistically significant (all P<0.05) . The diagnostic value in the active phase was higher than that in the remission phase (AUC>0.5) . The AUC of virtual single energy CT was the largest at 60 keV in arterial phase (0.924) , and the specificity of diagnosing CD intestinal segment in active phase was high (95%) , but the sensitivity was slightly poor (75%) . The AUC of the curve slope was the largest in the portal phase (0.731) , and the specificity of diagnosing CD intestinal segment in the active phase was high (85%) , but the sensitivity was low (58.3%) . The AUC of iodine content was the highest in arterial phase (0.885) , and the specificity of diagnosing CD intestinal segment in active phase was high (100%) , but the sensitivity was slightly poor (61.1%) . Conclusion:The virtual single energy CT value, energy spectrum curve slope and iodine content have good diagnostic value, good sensitivity and specificity in the evaluation of CD activity, which can provide reference for clinical accurate diagnosis of CD activity.

The risks of tumors in patients with inflammatory bowel disease (IBD) are significantly higher than that in normal people. It is still obscure whether anti-tumor necrosis factor (anti-TNF) agents increase the risks of malignant tumors in these patients and whether the patients with previous history of malignant tumors could use anti-TNF agents. It becomes an important issue for making clinical decisions.

The risks of tumors in patients with inflammatory bowel disease (IBD) are significantly higher than that in normal people. It is still obscure whether anti-tumor necrosis factor (anti-TNF) agents increase the risks of malignant tumors in these patients and whether the patients with previous history of malignant tumors could use anti-TNF agents. It becomes an important issue for making clinical decisions.

Objective To analyze the clinical characteristics of type 1 autoimmune pancreatitis (AIP) in patients.Methods The clinical data of 27 patients with type 1 AIP treated at Fujian Provincial Hospital from January 2012 to October 2018 were retrospectively analyzed.Results There are 25 males (92.6％) and 2 females (7.4％) (ratio 12.5∶1).The age of disease onset was (59.5 ± 14.3) years.The most common presenting symptoms were jaundice and abdominal pain (both 59.3％).The most common complication was IgG4-related sclerosing cholangitis (63.0％).Magnetic Resonance Cholangiopancreatograhpy (MRCP) conducted on 26 patients showed the diffuse type 1 AIP was most common (53.8％),only 2 patients (7.7％) presented with a main pancreatic duct stricture.The pancreatic segment of bile duct narrowing was very common (84.6％),and most patients presented as tapered narrowings (65.4％).Standard glucocorticoid therapy was given to these 27 patients who responded well with clinical and laboratory remissions.Two patients were given maintenance glucocorticoid therapy for a high level of serum IgG4.Conclusions Type 1 AIP can present as a local manifestation of IgG4-related disease.The most common complication is IgG4-related sclerosing cholangitis.Glucocorticoid therapy was effective but some patients required maintenance therapy.