Objective To evaluate the effect of nutritional intervention on neurological rehabilitation of the elderly stroke patients. Methods Forty elderly patients with sequelae of stroke were recruited and randomly divided into two groups (intervention group and control group). Nutritional intervention including patient and caregiver education and nutrient supplement was carried out for three months in intervention group in addition to the conventional pharmacotherapy and rehabilitative training, and only conventional pharmacotherapy and rehabilitative training were given to the patients of the control group. The nutritional status of both groups was examined monthly, and the infectious morbidity and neurological improvement in both groups were also monitored at the same time. Results There were significant differences between the intervention group and the control group with regard to the nutritional status as indicated by various parameters [albumin(39.65?6.11)g/L vs (37.48?6.57)g/L,hemoglobin(12.68?1.21)g/dl vs (11.72?1.81)g/dl,IgG(11.28?2.61)g/L vs (8.57?1.98)g/L,complement C3(0.84?0.11)g/L vs (0.62?0.09)g/L,BMI(25.26?3.81)vs (23.51? 3.73),all P

Objective To investigate the expression of serum Hsa_circ_0003928 in patients with diabetic foot ulcer(DFU)and its relationship with the severity and prognosis of disease.Methods 113 DFU patients were selected as the study subjects.According to the severity of infection,19 cases were classified into level 1(no infection),40 cases at level 2(mild infection),20 cases at level 3(moderate infection),and 34 cases at level 4(severe infection).According to the prognosis of DFU patients,they were divided into good prognosis group(GP,n=63)and poor prognosis group(PP,n=50).The baseline data and levels of IL-6,C-RP and Hsa_circ_0003928 were compared among the four groups.Logistic regression was used to analyze the risk factors of poor prognosis in patients with DFU.The receiver operating characteristic(ROC)curve was used to analyze the value ofHsa_circ_0003928,C-RP and IL-6 in predicting the poor prognosis in DFU patients.Results The DFU duration,infection grade 3～4,serum creatinine,uric acid,BUN,C-RP,IL-6 and Hsa_circ_0003928 levels in PP group were significantly higher than those in GP group(P＜0.05 or P＜0.01).Grade 3～4 DFU patients had higher Hsa_circ_0003928 expression than grade 1～2(P＜0.01).Logistic regression analysis showed that long duration of DFU,infection grade 3～4,higher levels of BUN,C-RP,IL-6 and Hsa_circ_0003928 were risk factors for poor prognosis in DFU patients.ROC curve showed that Hsa_circ_0003928 had the greatest AUC(0.882,95％CI 0.819～0.942)in predicting poor prognosis in DFU patients,with sensitivity 87.5％and specificity 85.6％,respectively.Conclusion Elevated Hsa_circ_0003928 is associated with DFU severity and poor prognosis,which has certain predictive value for the prognosis of DFU patients.

Objective To investigate and analyze the effectiveness of case management in community prevention and rehabilitation of severe mental illness. Methods A total of 360 patients with basic stable major psychiatric illness were randomly selected from 20 communities as the research objects, they were randomly divided into experimental group and control group, each group had 180 cases. The experimental group was given case management, control group were not adopt case management because patients did not agree to attend the case management. Two groups of patients were carried out for a 22-months standardized management and then the clinical efficacy, medication compliance, trouble-making assess the situation and life quality were recorded and compared. Results In the clinical efficacy, medication compliance, troublemaking assess the situation and life quality of experimental group were better than the control group, the differences were statistically significant (P all<0.05). Conclusion The case management can effectively im-prove the life quality of mental patients, increase the therapeutic effect, maintain and promote social harmony and has obvious social benefit and economic benefit.

Objective To evaluate the effect of active cycle of breathing techniques(ACBT) on promoting lung recruitment in post-thoracic surgery patients with lung cancer. Methods Totally 100 cases of patients with lung cancer were collected and randomly divided into two groups(the control group and the observation group) with 50 cases in each group. The additional ACBT was applied≥3 times per day in the control group compared with the observation group. The main observation indexes(pulmonary function and arterial blood gas, etc) and the secondary indexes(vital signs and pain score, etc) of the patients were collected at different time period. Results The main observation index and the secondary index of the patients in the control group gained an advantage over those in the observation group(P＜0.05). No obvious adverse events occurred. Conclusion ACBT applied in the post-thoracic surgery patients with lung cancer is safe and effective. It can improve the cleaning efficiency of respiratory secretion, promote lung recruitment and fastly recover the pulmonary function and save medical costs.

Objective:To provide basis for formulating standardized intervention plan of patients with enterostomy by integrating relevant qualitative studies to systematically evaluate the self-management experience of patients with enterostomy.Methods:PubMed, EMBASE, Web of Science, EBSCO (CINAHL), Joanna Briggs Institute (JBI), The Cochrane Library (central), CNKI, Wanfang databases, and VIP were searched for qualitative research related to the self-management experience of enterostomy patients from establishment to May 2022, the quality of articles were evaluated by the "quality evaluation standard of JBI evidence-based health care center (2014) in Australia", and results were summarized by Meta-integration.Results:A total of 8 studies were included, 22 complete research results were refined, 9 new categories were summarized, and 3 integrated results were obtained: the dilemma and obstacles of self-management, the process and growth of self-management, and the needs and prospects of self-management.Conclusions:The patients with enterostomy was increasing in recent years. The society should pay attention to the psychological problems of patients with enterostomy, strengthen education of disease risk cognition, and improve the construction of comprehensive information platform for self-management of enterostomy patients. By providing multiple support through online and offline channels, we can improve the self-care management ability of enterostomy patients, and enhance the quality of life in patients.

Objective: To investigate the association between aflatoxin exposure and primary hepatocellular carcinoma (PHC) development. Methods: From December 2013 to May 2016, we selected 214 patients newly diagnosed with PHC as cases, and 214 patients as controls from three hospitals in Chongqing. Cases were confirmed with PHC diagnosis standard. And cases caused by clear reasons such as drug-induced liver injury, alcoholic liver damage, fatty liver and gallstones etiology, were excluded. Controls were included with no cancer and no digestive system disease, and recruited simultaneously with cases. Cases and controls were frequency-matched (1∶1) by same gender and age (±3 years). Peripheral blood and random urine samples were collected and analyzed for serum HBsAg status by biochemistry analyzer, and serum AFB₁-ALB adduct and urinary AFB₁-N⁷-GUA adduct by ELISA. Basic information, living habits and history of disease for patients were obtained by questionnaires. We used wilcoxon rank sum test to compare the median of serum AFB₁-ALB adduct and urinary AFB₁-N⁷-GUA adduct in cases and controls. Logistic regression analyses were performed to assess risk factors for PHC, and synergism index (S) of aflatoxin with other factors was estimated by the method of Andersson. Results: There was no significant difference in age between PHC cases (50.74±9.67) years and controls (51.15±9.90) years. Logistic regression showed that the odds ratio of HBV infection for PHC development was 46.3 (95% CI: 23.3-88.0). There was a significant difference in median concentrations of serum AFB₁-ALB adduct (cases vs controls: 146.23 vs 74.42 ng/g albumin, P<0.001), but no difference in median concentrations of urinary AFB₁-N⁷-GUA adduct was observed (cases vs controls: 0.17 vs 0.14 ng/mg creatinine, P<0.210). The odd ratios for PHC risk after adjustment were 1.9 (95%CI: 1.1-3.4) for AFB₁-ALB adduct, and 2.1 (95%CI: 1.0-4.2) for AFB₁-N⁷-GUA adduct. Moreover, we observed a positive interaction of aflatoxin exposure with HBV, alcohol drinking, and diabetes. The S was 4.7 (95%CI: 2.8-7.9), 3.5 (95%CI: 1.0-12.0), and 12.4 (95%CI: 1.8-84.2), respectively for serum AFB₁-ALB adduct with each of the three factors mentioned, and was 1.9 (95%CI:1.1-3.1), 2.0 (95%CI: 1.1-3.6), and 2.0 (95%CI: 1.1-3.6), respectively for urinary AFB₁-N⁷-GUA adduct with each of the three factors mentioned. Conclusion HBV was still the main risk factor, and AFB₁ exposure was also an independent risk factor for PHC in Chongqing. There was a positive interaction of aflatoxin with HBV, alcohol drinking, and diabetes.

Objective:To retrieve, appraise and summarize the evidence for the airway humidification management of the inpatient with laryngectomy and tracheotomy but nonmechanical ventilation and to provide references for the clinical nursing.Methods:The evidence question was raised based on the study objective. The evidence was retrieved from some databases according to the evidence pyramid model during inception to December, 2018. The literature types included clinical practice guideline, evidence summary, best practice information sheet, recommended practice and systematic review. The quality of the literature were evaluated by the suitable evaluated tool based on their types. The level and recommedation grade of the evidence were appraised by the suitable tools of JBI.Results:Thirteen studies were recruited, including one clinical practice guideline, two evidence summaries, one best practice information sheet and nine systematic reviews. Totally thirteen items of best evidence were summarized and generalized to four categories including assessment, method, liquid and operation of airway humidification.Conclusion:The evidences of the studies are scientific and practical, but on the one hand, it is recommended that when applying the evidences in clinic, it is necessary to assess the clinical situation and chose the proper evidence. And on the other hand, there are lacking of some evidences of airway humidification and the level of some evidences is low. So it needs to create more high level evidences.

Objective To develop a self-care scale for patients with lymphedema after breast cancer surgery and verify its reliability and validity.Methods Based on the model of knowledge,belief and practice,a questionnaire item pool was constructed after literature reviews and qualitative interviews.A questionnaire-based scale was drafted based on the established item pool by carrying out two rounds of consultation with 15 clinical nursing specialists,nursing administrators and nursing educators from 8 provinces or cities in China.Reliability and validity of the scale were tested using convenience sampling,involving 444 patients with breast cancer surgery related lymphedema from 7 general hospitals in Hubei and Henan provinces,China,between May and July 2023.Results The response rates for the two rounds of expert consultation were 93.75%and 93.33%,respectively.The authority coefficients of the two rounds were 0.86 and 0.89,respectively,and the coordination coefficients for the 2 rounds were 0.130 and 0.379,respectively.In the first round,the average importance rating was from 4.33 to 4.93 with the coefficient of variation from 0.05 to 0.19,and the full score ratio from 53.33%to 93.33%.In the second round,the average importance rating ranged from 2.86 to 4.93 with the coefficient of variation from 0.05 to 0.36,and the full score ratios from 7.14%to 92.86%.A total of 421 patients completed the survey.The overall Cronbach's α coefficient of the scale was 0.943,the overall split-half reliability was 0.824,the scale-level content validity index(S-CVI)was 0.912,and the item-level content validity index(I-CVI)of the total scale ranged from 0.857 to 1.000.The KMO value of exploratory factor analysis was 0.919,the Bartrett spherical test value was 4671.724(P<0.001),and the cumulative variance contribution rate was 64.155%.Confirmatory factor analysis showed a good model fit.After the reliability and validity tests,the scale was finalised and determined to consist of three dimensions with 33 items:knowledge(9 items),attitude(6 items)and behaviour(18 items).Conclusion The self-care scale for the patients with lymphedema after breast cancer surgery has demonstrated good reliability and validity,and makes it an effective assessment tool for the patients with lymphedema after breast cancer surgery.

Venous thromboembolism(VTE)is an important etiology for unexpected deaths and perioperative deaths of inpatients. Early diagnose and early prevention are main measures to reduce the incidence and mortality of VTE. Herein, we have established a comprehensive management system of VTE prevention, treatment and research. On one hand, we implemented the in-hospital VTE prevention management and improved the implementation status of VTE prevention and treatment. As a result, the number of diagnosed VTE cases and related medical disputes decreased by years. On the other hand, we have built up the VTE monitoring platform, providing useful statistical data for the clinical use of anticoagulants and further reducing the incidence of VTE. The VTE monitoring platform also revealed some significant differences of the VTE incidence between the medical patients and the surgical patients, which could provide reference for further revision of VTE guidelines.

OBJECTIVE: To study the anti- fibrotic effect of human umbilical cord mesenchymal stem cell-derived exosomes (hUCMSC-EXOs) and explore the mechanism. METHODS: Twenty-four C57 BL/6 mice were divided into 4 groups (=6), including the control group treated with intratracheal injection of saline (3 mg/kg); lung fibrosis model group with intratracheal injection of 1.5 mg/mL bleomycin solution (prepared with saline, 3 mg/kg); EXOs1 group with intratracheal injection of 1.5 mg/mL bleomycin solution (3 mg/kg) and hUCMSC-EXOs (100 μg/250 μL, given by tail vein injection on the next day after modeling); and EXOs2 group with intratracheal injection of 1.5 mg/mL bleomycin solution (3 mg/kg) and hUCMSC-EXOs (100 μg/250 μL, given by tail vein injection on the 10th day after modeling). At 21 days after modeling, pulmonary index, lung tissue pathology and collagen deposition in the mice were assessed using HE staining and Masson staining. The expression level of TGF-β1 was detected using ELISA, and vimentin, E-cadherin and phosphorylated Smad2/3 (p-Smad2/3) were detected using immunohistochemical staining. CCK8 assay was used to evaluate the effect of hUCMSCEXOs on the viability of A549 cells, and Western blotting was used to detect the expression levels of p-Smad2/3, vimentin, and E-cadherin in the cells. RESULTS: Compared with those in the model group, the mice treated with hUCMSC-EXOs showed significantly reduced the pulmonary index ( < 0.05), collagen deposition, lung tissue pathologies, lowered expressions of TGF-β1 ( < 0.05), vimentin, and p-Smad2/3 and increased expression of E-cadherin. hUCMSC-EXOs given on the second day produced more pronounced effect than that given on the 11th day ( < 0.05). CCK8 assay results showed that hUCMSC-EXOs had no toxic effects on A549 cells ( > 0.05). Western blotting results showed that hUCMSC-EXOs treatment significantly increased the expression of E-cadherin and decreased the expressions of p-Smad2/3 and vimentin in the cells. CONCLUSIONS hUCMSC-EXOs can alleviate pulmonary fibrosis in mice by inhibiting epithelialmesenchymal transition activated by the TGF-β1/Smad2/3 signaling pathway, and the inhibitory effect is more obvious when it is administered on the second day after modeling.
Animals ; Epithelial-Mesenchymal Transition ; Exosomes ; Gene Expression Profiling ; Gene Expression Regulation ; Humans ; Mesenchymal Stem Cells ; cytology ; Mice ; Pulmonary Fibrosis ; therapy ; Transforming Growth Factor beta1 ; genetics ; Umbilical Cord ; cytology