Objective To investigate the associations of Toll-like receptors (TLRs) mRNA expressions and their downstream signaling pathways in peripheral blood mononuclear cells with clinical outcomes in patients with cerebral infarction.Methods Ninety patients with cerebral infarction of anterior circulation,admitted to our hospital fiom May 2015 to December 2015,were chosen.Quantitative real-time PCR was performed to measure the expressions ofTLR2,TLR4,TLR3,TLR7,TLR8 and TLR9 and downstream signaling molecules Toll-like receptors related molecule (TRAM),interferon regulatory factor 3 (IRF-3),and interferon beta (IFN-β) in peripheral blood mononuclear cells.Good functional outcome was defined as modified Rankin Scale (mRS) scores≤ 2 90 d after onset.National Institutes of Health Stroke Scale (NIHSS) on admission was used to evaluate the severity of stroke,and infarct volume 7-14 d after onset was measured on MR imaging.The baseline characteristics (TLRs,population information,risk factors,stroke types,clinical and imaging data) were compared between patients with good and bad functional outcomes.Multi-factor Logistics regression analysis was performed.Results TLR3 and TLR7 mRNA expressions were correlated with good functional outcome at acute cerebral infarction,and only TLR3 expression was correlated with good functional outcome at sub-acute phase.TLR3 mRNA expression,C-reactive protein (CRP) level,and NIHSS scores on admission were positively correlated with good outcome (OR=4.435,P=0.001;OR=l.12,P=0.033;OR=1.961,P=0.000).The expressions of TLR3 and IRF-3 were both inversely correlated with NIHSS scores and cerebral infarction volume;IFN-β mRNA expression was positively correlated to TLR3 expression (r=0.392,P=0.000);IFN-β expression and IRF level were positively correlated (r=0.347,P=0.01).Conclusion The TLR3 expression is correlated with good functional outcome in peripheral blood mononuclear cells of patients with cerebral infarction,which may play a crucial role in the survival of neurons after ischemia through spuring the extraction of anti-inflammatory factor IFN-β.

Objective To investigate inner experience of junior nurses after a serious adverse event.Methods A total of 7 junior nurses undergoing a serious adverse event were interviewed from June to August 2016, using the phenomenological approach in qualitative research. The interview was analyzed by phenomenological methodology. The information was dealt with Colaizz 7 steps analysis method.Results The perception of junior nurses experiencing a serious adverse event could be classified into 3 themes: emotional changes in different periods, family attitude having an impact, the pursuit of nursing work having some changes. Conclusions The interview of junior nurses can help them undergoing a serious adverse event to express inner feelings, which shorten the time of mental health and provide the basis for the research on nursing adverse event management system.

Objective To explore the application effects of nurse-physician combined outpatient service in peptic ulcer patients. Methods A total of 108 cases of peptic ulcer patients who were being treated in the digestive center of the Affiliated Hospital of Medical College of Ningbo University from January 2015 to February 2017 were recruited in the research by purposive sampling method, and randomly divided into experimental group and control group, with 54 cases in each. Nurse-physician combined outpatient service was provided to the patients in the experimental group, while the patients in the control group received traditional outpatient mode. Disease knowledge, medication compliance and lifestyle were compared between the two groups. Results In the 1st, 2nd and 6th week, patients' disease knowledge in the experimental group was better than that in the control group, and the difference was statistically significant (P<0.01). In the 2nd week, the medication compliance of the experimental group was better than that of the control group, with statistically significant (P<0.05). In the 1st, 2nd and 6th week, the number of smoking and drinking people was less than that of the control group, and the difference was statistically significant (P<0.05). Conclusions The nurse-physician combined outpatient service is beneficial to improve the knowledge level and medication compliance of patients and plays an important role in changing unhealthy living habits.

Objective To explore the effect of fall risk assessment software in electronic medical record system used by junior nurses. Methods By retrospective study, the fall events reported by electronic medical record system between 2014 and 2015 were analyzed. The prediction rate for high risk falls and the incidence of falls related to junior nurses were compared before and after using fall risk assessment software, and the effect of fall risk assessment software on cognition and safety attitude of junior nurses was analyzed by revised report cognitive questionnaire and patient safety culture assessing scale about clinical nurse. Results After using fall risk assessment software, the prediction rate for high risk falls of junior nurses was higher than before (54.9% vs 25. 9%), and the difference was statistically significant (P<0.01). The incidence of falls related to junior nurses reduced to 40%, and the difference was statistically significant ( P<0. 05 ) . The cognition of nursing adverse event report improved significantly. The total score of patient safety culture assessing scale and the scores of all dimensions were increased. The differences were statistically significant (P<0.05).Conclusions Fall risk assessment software in electronic medical record system can improve the junior nurses′ ability of preventing adverse events, strengthen their security beliefs, and ensure the safety of care.

Objective To explore the effect of continuous suction by small pipe in trachea cannula for patients after tracheotomy.Methods Totally 60 patients with tracheotomy in Neurosurgery Ward and ICU, the Affiliated Hospital of School of Medicine of Ningbo University were included by purposive sampling from January 2015 to August 2016, and were divided into observation group (n=30) and control group (n=30) by random number table method. Tracheostomy mask joint oxygen Inhalation by heating humidifier was applied in both groups, without using breathing machine. Routine nursing methods of tracheotomy was carried out in the control group, while continuous suction by small pipe in trachea cannula were used in the observation group. Respiratory complications and nursing workload of the two groups were compared during the first week after tracheotomy.Results In observation group, there were 3 cases of irritative cough, 2 cases of respiratory hemorrhage, 3 cases of hypoxemia while sputum suctioning, and the complications rate was lower than control group(21, 14, 16), the differences were statistically significant (χ2=22.500, 12.273, 13.017;P<0.05). Times of suction in observation group and control group were (8.57±4.76) and (66.77±26.34), respectively, the difference was statistically significant (t=-11.908,P<0.01).Conclusions Continuous suction by small pipe in trachea cannula is a safe and effective method which could obviously reduce the respiratory complications while suctioning, decrease the times of endotracheal suction, as well as the workload of the nurse.

AIM:To analyze the influencing factors of visual outcome after vitrectomy for polypoidal choroidal vasculopathy(PCV)combined with vitreous hemorrhage and establish a predictive model.METHODS: A retrospective analysis was conducted on the clinical data of 129 cases(129 eyes)of patients who underwent vitrectomy for PCV combined with vitreous hemorrhage from June 2021 to January 2024 in our hospital. They were divided into elevated group(71 eyes)and non-elevated group(58 eyes)according to visual outcome at early posoperative stage(within 24 mo). Another 30 cases(30 eyes)of PCV with vitreous hemorrhage undergoing vitrectomy were selected as external validation data. The predictive value of the model for the postoperative visual outcomes of both internal and external populations was evaluated.RESULTS: The non-elevated group had a higher proportion of patients aged ≥60 years, diabetes, continuous abnormalities of the ellipsoid zone(EZ)during surgery, bleeding involving the macular fovea, and postoperative retinal scar formation than the elevated group were independent factors affecting postoperative visual acuity(all P<0.05). The AUC of the predictive model for predicting the postoperative visual outcomes of internal and external populations was 0.824(95%CI: 0.750-0.898)and 0.809(95%CI: 0.723-0.865), respectively.CONCLUSION:Patients aged ≥60 years, diabetes, intraoperative continuous abnormalities of EZ, bleeding involving the macular fovea, and postoperative retinal scar formation are influencing factors for visual outcome after vitrectomy in patients with PCV combined with vitreous hemorrhage. A predictive model based on those factors has been established, which has a certain predictive value for postoperative visual outcome.