Objective:To formulate a ladder type early activity program in order to provide a theoretical and practical basis for improving the current activity status of tumor patients with pulmonary embolism.Methods:This research was conducted experimentally. A total of 92 tumor patients diagnosed as pulmonary embolism from January 1, 2021 to March 31, 2022 in Sichuan Cancer Hospital were divided into control group and experimental group with 46 cases each by random number table method. In the control group, a routine activity program was carried out, and the patients were confined to bed for 7 days. The experimental group obtained the best evidence of early pulmonary embolism activity plan through evidence-based nursing, formed a nurse-led ladder type early pulmonary embolism activity team, and finally constructed and implemented the ladder type early activity plan. The mortality rate, new thrombosis in ICU for 3 days and 7 days, length of stay in ICU and patients′ comfort were compared between the two groups.Results:The mortality rates within 30 days after the diagnosis of pulmonary embolism were 4.35% (2/46) and 2.17% (1/46) respectively in the control group and the experimental group, with no significant difference between the two groups ( χ2=0.35, P>0.05). The rates of new thrombosis were 15.22% (7/46) and 26.09% (12/46) in the control group, and 4.35% (2/46) and 4.35% (2/46) in the experimental group, respectively at 3 and 7 days after ICU admission, with a significant difference between the two groups at 7 days after ICU admission ( χ2=8.43, P<0.05). The length of stay in ICU and the score of General Comfort Questionnaire (GCQ) were (15.74 ± 11.11) days and (64.30 ± 15.54) points in the experimental group, respectively, while those in the control group were (11.07 ± 5.63)days and (73.84 ± 11.73) points, respectively. The difference between the two groups was statistically significant ( t=-2.55, -3.32, both P<0.05). Conclusions:The evidence-based ladder type early activity program for patients with pulmonary embolism caused by tumor will not increase the mortality of patients, but can ensure the safety of patients, reduce the incidence of new thrombosis and the length of ICU stay, improve the comfort of patients during the treatment of pulmonary embolism. It is worthy of clinical application.

Objective: To develop a method for generating three-dimensional (3D) digital models of the periodontal ligament (PDL) using 3D cone-beam computed tomography (CBCT) reconstruction and to evaluate the accuracy and agreement of the 3D PDL models in the measurement of periodontal bone loss. Methods: CBCT data collected from four patients with skeletal Class III malocclusion prior to periodontal surgery were reconstructed at three voxel sizes (0.2 mm, 0.25 mm, and 0.3 mm), and 3D tooth and alveolar bone models were generated to obtain digital PDL models for the maxillary and mandibular anterior teeth. Linear measurements of the alveolar bone crest obtained during periodontal surgery were compared with the digital measurements for assessment of the accuracy of the digital models. The agreement and reliability of the digital PDL models were analyzed using intra- and interexaminer correlation coefficients and Bland–Altman plots. Results: Digital models of the maxillary and mandibular anterior teeth, PDL, and alveolar bone of the four patients were successfully established. Relative to the intraoperative measurements, linear measurements obtained from the 3D digital models were accurate, and there were no significant differences among different voxel sizes at different sites. High diagnostic coincidence rates were found for the maxillary anterior teeth. The digital models showed high intra- and interexaminer agreement. Conclusions Digital PDL models generated by 3D CBCT reconstruction can provide accurate and useful information regarding the alveolar crest morphology and facilitate reproducible measurements. This could assist clinicians in the evaluation of periodontal prognosis and establishment of an appropriate orthodontic treatment plan.

Objective:To evaluate the effect of two-step irradiance schedule on pain control during and clinical efficacy of aminolevulinic acid (ALA) -based photodynamic therapy (PDT) for moderate to severe acne.Methods:Sixty patients with moderate to severe acne were enrolled from the Department of Dermatology, the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture from January 2018 to March 2019, and equally divided into 2 groups according to the order of treatment: control group receiving conventional irradiation at a light output intensity of 65 mW/cm 2 for 20 minutes, and observation group irradiated at an initial light output intensity of 40 mW/cm 2 for 8 minutes until the irradiation energy reached 20 J/cm 2, followed by irradiation at a light output intensity of 65 mW/cm 2 for 15 minutes until the total irradiation energy reached 78 J/cm 2. During the treatment, the irradiation intensity was appropriately adjusted according to the patients′ response, and all the patients were treated once every 2 weeks for 3 consecutive sessions. The time to onset of pain and pain scores at 5, 10, 15, 20, 25, 30 and50 minutes after the start of irradiation were recorded and compared between the two groups; clinical efficacy was evaluated 1 month after the end of the treatment; other adverse reactions were recorded during the treatment and 3-month follow-up after the end of treatment. Results:The time to onset of pain was significantly different between the observation group (10.40 ± 1.13 minutes) and the control group (3.95 ± 0.77 minutes; t = 25.919, P < 0.05). During the treatment, the pain score significantly changed over time ( F = 323.631, P < 0.01), and significantly differed between the observation group and control group ( F = 89.338, P <0.01). Additionally, there was a significant interaction between the treatment duration and treatment methods ( F = 24.059, P < 0.01). At 5, 10 and 15 minutes after the start of irradiation, the pain score was significantly lower in the observation group than in the control group ( t = 21.714, 28.407, 28.286 respectively, all P < 0.05) ; at 20 minutes, there was no significant difference in the pain score between the two groups ( t = 1.505, P > 0.05) ; at 25 minutes (that is, 2 and 5 minutes after the end of irradiation in the observation group and control group respectively), 30 minutes, 50 minutes (that is, the end of the cold compress), there was also no significant difference in the pain score between the two groups ( t = 0.606, 1.038, 0.344 respectively, all P > 0.05) ; at the end of irradiation (that is, 23 and 20 minutes after the start of irradiation in the observation group and control group respectively), there was still no significant difference in the pain score between the two groups ( t = 1.968, P = 0.149). One month after the 3 sessions of treatment, there was no significant difference in the response rate between the observation group (90%, 27/30) and control group (83.3%, 25/30; χ2 = 0.577, P = 0.706). Moreover, there was no significant difference in the incidence of blisters, erythema, edema, skin dryness, desquamation, pruritus, reactive acne or pigmentation between the two groups (all P > 0.05) . Conclusion:The two-step irradiance schedule can effectively control related pain during the treatment of moderate to severe acne with ALA-PDT, especially in the initial stage of treatment, making patients successfully complete 3 sessions of ALA-PDT treatment and ensuring the clinical efficacy.