As a kind of breast cancer surgery choice,the nipple-sparing mastectomy (NSM)saves the patients′nipple-areola complex (NAC)which has significant meaning for patients′cosmetic results and posto-peration reconstruction.However,the clinical application of NSMis still in controversial.Some hot topics about oncological safety of NSM have appeared in recent years,such as the screening criterion of the enrolled patients,the situation of NAC involvement and the complications after NSM and handing methods.

Objective To standardize an expert consensus on pulmonary rehabilitation nursing of chronic respiratory diseases. Methods On the basis of literature review, 5 experts were interviewed and 19 experts were consulted to establish the primary and secondary themes. 10 nursing experts in this field were invited to conduct peer review on the draft consensus to modify and improve the consensus content. Results After expert consultations，14 first-level themes and 40 second-level themes were established. The value of Ca (judgment coefficient),Cs (familiarity coefficient) and Cr (authority coefficient) were 0.895,0.839 and 0.867 ,which indicated the expert consultation have high authority and credibility. The Kendall coefficients of first-round expert consultation were 0.121 and 0.151, and they were 0.205 and 0.149 in the second round (P<0.05).In the first-round expert consultation, the coefficients of variation of the first and second themes were 0.197 and 0.200,and in the second round ,they were 0.202 and 0.237. They were all less than 0.25 , indicating that the expert's judgment results were relatively consistent. Conclusion As this consensus was developed based on 19 clinical nursing professionals from across the country, it is scientific and authoritative. This consensus can not only benefit to clinical nursing practice, but also lay the foundation for the development of guideline, and it still needs further theoretical and empirical research verification.

Objective To investigate the psychological resilience status and its influencing factors of lung cancer patients. Methods A total of 182 patients with lung cancer were selected by convenient sampling method and were investigated the psychological resilience with Chinese Version Connor and Davidson′s resilience scale ( CD-RISC ) , the Chinese version of medical coping modes questionnaire ( MCMQ ) , and the hospital anxiety and depression Scale ( HAD) . Results The total score of resilience in 182 lung cancer patients acquired (65. 2 ± 15. 0). The total score of resilience in 82 preoperative patients was (68. 9 ± 15. 4), postoperative patients (63.5 ±13.6), chemotherapy patients (60.3 ±14.3); resilience status showed down trend (F=5.530,P<0. 05). Different educational background, marriage status, medical insurance type, treatment stage and cancer metastasis had difference of psychological resilience (P<0. 05). The average anxiety score of 182 cancer patients was (5. 72 ± 4. 52) and depression score obtained (4. 74 ± 4. 39). The correlation analysis presented that lung cancer patients′psychological resilience had negative correlation with anxiety, depression and surrender while it had positive correlation with confrontation (P <0. 05), but had no correlation with avoidance (P>0.05). Multiple regression analysis revealed treatment stages, copying strategies and depression were the main influencing factors which all explained 45. 8% of total variation. Conclusions Resilience of patients with lung cancer are at a lower level, which effected by many factors. Nursing staffs should pay attention to patients psychological status, take effective measures to help them to get higher level of psychological resilience, so as to improve quality of life.

Objective:To analyze and explore the clinical characteristics and risk factors related to nosocomial mortality in patients with liver cirrhosis combined with atrial arrhythmia.Methods:252 hospitalized patients with liver cirrhosis combined with atrial arrhythmia from January 2014 to December 2021 were enrolled, and their clinical characteristics were analyzed. The above-mentioned patients were divided into groups according to their nosocomial mortality rate. Among them, 45 nosocomial mortality cases were classified as the mortality group, and 207 survival cases were classified as the survival group. The differences in clinical data and laboratory data between the two groups were compared. The risk factors for nosocomial mortality in patients with liver cirrhosis combined with atrial arrhythmia were analyzed. The t-test, or rank-sum test, was used to compare measurement data. The chi-square test, or Fisher's exact probability method, was used to compare enumeration data. Multivariate analysis was performed by the logistic regression method.Results:Among the 252 cases, the male-to-female ratio was the same (male/female ratio: 126/126). The age range was 26 to 89 (66.77±10.46) years. Han ethnicity accounted for 79.5%. The main type of atrial arrhythmia was atrial fibrillation ( P ?

Objective? To evaluate and summarize the best available evidence of kangaroo mother care for premature infants both in China and abroad, and to provide evidence-based support for clinical practice. Methods? Evidence on kangaroo mother care including evidence-based guidelines, best practices, systematic evaluation and so on were systematically retrieved from databases such as UpToDate, Cochrane Library, Ontario Registered Nurses Association of Canada, National Institute for Health and Care Optimization of the United Kingdom and National Guidelines Network of the United States from the establishment of the database to December 15th, 2018. Four researchers were divided into two groups and evaluated the quality of literature and extracted data. Results? Eight papers were included, including one guideline and seven systematic reviews. The best evidence included suitable population, support system, skin contact (timing, duration, operator), breast feeding support, etc. After evidence extraction, evidence aggregationin combination with localized adjustment in clinical situation, this study has formed eight best evidences. Conclusions? It is necessary to strengthen and support the education of relative knowledge about kangaroo mother care, improve the facilities and promote the development of clinical kangaroo mother care based on the evidence and consider the special humanistic attributes with clinical environment at the same time .

Objective:To retrieve and analyze the relevant guidelines for the second and third stages of normal delivery, and summarize the evidence of high-quality guidelines so as to provide references for the formulation of clinical practice programs.Methods:We took Johns Hopkins evidence-based nursing practice model as theoretical guidance and set up an evidence-based team.We systematically searched major guideline publication websites, electronic resource databases, related academic groups and guideline networks at home and abroad, evaluated guidelines and summarized the best evidence, and the search time limit was up to June 1, 2019. The literature quality evaluation and evidence extraction were carried out independently by four researchers with evidence-based training.Results:This study included two guidelines, summarizing the 20 best evidences in 9 aspects of humanistic support, delivery companion, delivery position, fetal monitoring, delayed exertion, perineal protection, fundus compression, prevention of postpartum hemorrhage, and delayed umbilical cord clamping.Conclusions:Based on the existing evidence, it integrates the best evidence of nursing measures for the second and third stages of normal delivery. It is recommended that maternal and child institutions promote the transformation of the best evidence based on their actual conditions.

Objective:To investigate the differentially expressed microRNAs (miRNAs) in human gastric carcinoma SGC-7901 cell-derived exosomes induced by Helicobacter pylori ( H. pylori), providing new clues for further elucidating the carcinogenic mechanism of H. pylori. Methods:Ultracentrifugation and exosome extraction kit were used to extract the exosomes released by the H. pylori-stimulated and negative control group, and transmission electron microscope(TEM), nanoparticle tracking analysis(NTA) and Western blot experiments were employed to identify exosomes. Then, exosomes were labeled with the fluorescent dye PKH67 and co-cultured with THP-1-derived macrophages. The internalization of exosomes by macrophages was observed by laser confocal fluorescent microscopy. Additionally, miRNA microarray chips were performed to detect the differentially expressed miRNAs of exosomes from the two groups of cells. Real-time fluorescence quantitative PCR (qRT-PCR) was used to verify the expression of four differentially expressed miRNAs. Furthermore, the target genes and their functions as well as the possible signal pathways involved of partial differentially expressed miRNAs were predicted and analyzed by bioinformatics software. Differentially expressed miR-382-5p was labeled by Cy3 to observe whether it could be transferred to macrophages through exosomes. The expression of phenotype molecule CD206 and the cytokines TNF-α, IL-6 and IL-10 in miR-382-5p mimic-transfected macrophages were analyzed by qRT-PCR and ELISA, and the proportion of cells expressing CD206 and HLA-DR was analyzed by flow cytometry. Results:The extracted exosomes were consistent with exosome morphology and highly expressed the surface marker proteins CD9, CD63 and TSG101. After co-culturing with THP-1 derived macrophages for 12 h, the exosomes could be internalized by macrophages. Compared with the control group, there were 130 up-regulated miRNAs and 111 down-regulated miRNAs in the H. pylori-stimulated group. Bioinformatic analysis showed that the potential target genes of partial differentially expressed miRNAs were mainly involved in the regulation of PI3K-AKT, NF-κB, JAK-STAT, stem cell pluripotency and other inflammation and tumor-related pathways. miR-382-5p could be transferred to macrophages through exosomes, and induced the expression of M2-type phenotype molecule CD206 and cytokines IL-10 in macrophages, while inhibited the expression of TNF-α and IL-6 and increased the proportion of CD206 high HLA-DR low cells. Conclusions:H. pylori treatment caused a significant change in the expression level of exosome miRNAs in SGC-7901 cells. Bioinformatics analysis demonstrated that the prospective targets of these differentially expressed miRNAs might play an important role in the regulation of inflammation and tumor-related signaling pathways. miR-382-5p might induce the M2-type polarization of macrophages.

Objective To explore the application and effect of case management model in patients with lung cancer .Methods Totally 88 patients with lung cancer were divided into the experimental group and the control group according the wards .The patients in the experimental group received a six-month case management program, while the patients in the control group received routine nursing and follow-up.The quality of life of patients was evaluated at the first day of admission after diagnosis , one month, three months and six months after the treatment.The changes of several indexes in half a year during the study were analyzed by repeated -measure analysis of variance and multiple factor analysis of variance .Results In the experimental group , the scores of the patients in physical functioning , role functioning and global health status were higher than that in the control group after six-month′s nursing care (F=19.449,13.291,4.929;P<0.05); the scores of patients in the experimental group in appetite loss , fatigue, dyspnea and pain were lower than that in the control group ( F=5.032,5.152,4.287,10.734;P<0.05).Conclusions The case management model can improve the quality of life of lung cancer patients , and it should be applied to the lung cancer patients with condition .

OBJECTIVE: To observe the clinical effect of multistep breathing training combined with acupoint plastering on the treatment of patients with occupational coal worker's pneumoconiosis(CWP). METHODS: Eighty cases of male occupational CWP patients were selected as the research subject using convenient sampling method. They were divided into control group(40 cases) and treatment group(40 cases) according to random number table method. The control group was given conventional treatment, while the treatment group received multistep respiratory training combined with acupoint plastering for 12 weeks based on conventional symptomatic treatment. Before and after treatment, clinical curative effect, pulmonary function, immune function, the total score of Chronic Obstructive Pulmonary Disease Assessment Test(CAT) Questionnaire and 6 minutes walk distance(6 MWDS) in two groups were observed. RESULTS: Before treatment, there was no statistical difference on forced vital capacity(FVC), ratio of forced expiratory volume in one second(FEV_1)/FVC, lymphocyte cluster of differentiation(CD) 4~+/CD8~+ ratio, percentage of natural killer cells(NK), total CAT scores and 6 MWD(P>0.05). After treatment, the FVC, FEV_1/FVC ratio and lymphocyte CD4~+/CD8~+ ratio increased [median: 78.3% vs 80.7%, 68.7% vs 72.5%, 1.16 vs 2.00, P<0.01], 6 MWD was increased [(430.6±45.9) vs(494.8±58.7) m, P<0.01], and CAT total score was decreased [(18.1±5.6) vs(15.5±5.3) points, P<0.01] in the treatment group compared with the control group. There was no significant difference in NK cell percentage between the two groups(P>0.05). CONCLUSION: Multistep respiratory training combined with acupoint plastering can alleviate the clinical symptoms such as cough, and shortness of breath of patients with CWP, improve their lung function, regulate the function of immunity, as well as improve sports endurance.

Objective:To analyze the correlation between the root resorption rate and tooth movement of the maxillary and mandibular incisors before and after orthodontic treatment in adult patients using cone-beam CT (CBCT), and to explore the related factors that affect the apical root resorption.Methods:In this retrospective study, 23 adult patients with classⅠor class Ⅱ division 1 malocclusion [2 males and 21 females, mean age (23.4±6.3) years, treatment time (2.1±0.7) years] who received orthodontic treatment with fixed appliance in Department of Oral & Cranio-Maxillofacial Surgery, Shanghai Ninth People′s Hospital from January 2017 to June 2021 were enrolled. Full-column CBCT examination was performed before and after treatment. A three-dimensional model was established to observe and record the volume of the maxillary and mandibular central and lateral incisors before and after treatment. The change of the incisal edge, the angle of rotation of the incisal edge, and the direction of the long axis of the tooth were also measured. The root resorption in each tooth before and after treatment was compared, and the root resorption rate was calculated. Pearson correlation analysis was performed on the root absorption rate before and after treatment with age, treatment time and tooth movement.Results:After treatment, the tooth volume of the maxillary and mandibular central and lateral incisors decreased significantly ( P<0.01). The root absorption volumes were (20.2±6.0) mm 3 and (11.2±4.7) mm 3 in maxillary central and lateral incisors, and (14.7±4.6) mm 3 and (14.8±5.0) mm 3 in mandibular central and lateral incisors, respectively. The root absorption rates were (9.49±1.75)% and (9.13±3.24)% in maxillary central and lateral incisors, and (8.56±3.43)% and (9.65±2.76)%, in mandibular central and lateral incisors, respectively ( F=0.56, P=0.640). The root resorption rate of maxillary central incisors had a weak positive correlation with the change of sagittal distance of incisal edge ( r=0.36, P=0.015). The root resorption rate of mandibular central incisors had a moderate positive correlation with the vertical movement distance ( r=0.48, P=0.001). The root resorption rate of mandibular lateral incisors was weakly positively correlated with the vertical movement of incisal edge and the treatment time ( r=0.35, P=0.016; r=0.34, P=0.021), and was moderately positively correlated wit the change of sagittal movement of incisal edge ( r=0.44, P=0.002). Conclusions:During orthodontic treatment, both maxillary and mandibular incisors had a certain degree of root resorption, which was related to sagittal and vertical movement of the incisors and the time of orthodontic treatment.