Objective To evaluate the difference in coronary microcirculation and short term prognosis in patients with different collateral circulation and underwent elective percutaneous coronary intervention ( PCI) with complete occlusion of coronary artery. Methods The study included 42 patients who had been admitted in our hospital for NSTEMI or STEMI between 01/2012 to 12/2015 without receiving revascularization treatment and whose symptoms persisted for over 6 months. According to the results of coronary angiography and the Rentrop grade, the patients were divided into 2 groups: poor collateral circulation formation group (group A, Rentrop=0 -1, n=17) and well established collateral circulation group (group B, Rentrop=2-3, n=25). The basic clinical data and the result of coronary angiography were compared. A pressure-temperature sensor wire was used to measure index of mierocirculatory resistance ( IMR) immediately after PCI. An echocardiograph was used to measure left ventricular end systolic diameter ( LVEDd) and left ventricular ejection fraction ( LVEF) postoperatively and again at 3 months after operation to evaluate the changes in cardiac function. Results The IMR value of group A was significantly higher than group B (P﹤0. 05), the grade of collateral circulation had negative correlation with IMR value (r=-0. 671, P﹤0. 05). The mean changes in LVEDd in 3 months in group B was -0. 28 mm, while in group A was 5. 76 mm (P﹤0. 05). The mean changes in LVEF in 3 mouths in group B was 5. 36% and in group A was -3. 82% (P﹤0. 05). The grading of coronary collateral circulation had negative correlation with the changes of LVEDd in 3 months (r= -0. 669, P﹤0. 05), but had positive correlation with the changes of LVEF (r=0. 657, P ﹤0. 05). The IMR value had positive correlation with the changes of LVEDd in 3 months (r=0. 686, P﹤0. 05), but had negative correlation with the changes of the LVEF (r= -0. 664, P﹤ 0. 05 ) . Conclusions Patients with poor collateral circulation was more prone to coronary microcirculatory injury than patients with good collateral circulation. Patients with good collateral circulation and microcirculation had better prognosis after the revascularization of the infarction-related vessel.

Objective To investigate the distribution of vaginal microbiota in women with early-onset pre-eclampsia(PE)complicated by preterm premature rupture of membranes(PPROM)and the effect of differ-ent vaginal microbiota distribution on pregnancy outcomes.Methods A total of 120 pregnant women with early-onset PE admitted to this hospital from January 2019 to January 2022 were selected as the research ob-jects.Among them,67 pregnant women complicated with PPROM were selected as the observation group,and 53 pregnant women without PPROM were selected as the control group.The distribution of vaginal microflora was compared between the two groups,and the pregnancy outcomes of patients with early-onset PE complicat-ed with PPROM were analyzed.Results In terms of dominant bacteria,the proportion of Lactobacillus in the observation group was lower than that in the control group,and the proportion of Gram-positive bacilli,Gram-negative bacilli and Gram-positive cocci in the observation group were higher than that in the control group,and the differences were statistically significant(P＜0.05).In terms of pathogenic bacteria,the proportion of Glucococcus haemolyticus and Enterobacter cloacae in the observation group were higher than that in the con-trol group,and the differences were statistically significant(P＜0.05).In terms of vaginal flora density,the proportion of Ⅱ and m grade in the observation group were lower than that in the control group,and the differences were statistically significant(P＜0.05).In terms of the diversity of vaginal flora,the proportion ofⅡ and m grade in the observation group were lower than that in the control group,and the differences were statistically significant(P＜0.05).The imbalance rate of vaginal microecosystem in the observation group was 80.60％,which was higher than 45.28％in the control group,and the difference was statistically signifi-cant(x2=81.340,P＜0.001).Compared with the control group,the blood pressure was higher,24 h urine volume was lower,24 h urinary protein was higher,platelet was higher,prothrombin time and activated partial thromboplastin time were prolonged in the observation group after treatment(all P＜0.05).There were 10 cases of fetal growth restriction,8 cases of fetal intrauterine distress and 4 cases of neonatal asphyxia in the observation group,and 3 cases of fetal growth restriction,1 case of fetal intrauterine distress and 0 case of neo-natal asphyxia in the control group.The incidence of perinatal complications in the observation group(32.84％)was significantly higher than that in the control group(7.55％),and the difference was statistically significant(P＜0.05).Among 67 cases of early-onset PE complicated with PPROM,54 cases had dysbiosis(dysbiosis group)and 13 cases had normal microflora(normal microflora group).The incidence of adverse pregnancy outcomes in the dysbiosis group was 81.48％,which was higher than 46.15％in the normal micro-flora group(x2=5.089,P=0.024).Compared with the normal microflora group,the neonatal birth weight of the dysbiosis group was significantly lower(t=2.196,P=0.032),and the length of hospital stay was signifi-cantly longer(t=7.463,P＜0.001).Conclusion The imbalance of vaginal flora in women with early-onset PE complicated with PPROM may lead to adverse pregnancy outcomes.In clinical practice,it is necessary to pay attention to the changes of vaginal flora and intervene in time to reduce the risk of adverse pregnancy out-comes.

Objective To evaluate the clinical effects of heated humidified high flow nasal cannula oxygen therapy on post-extubation intensive care unit(ICU)patients. Methods A computerized search was performed through Cochrane Library,EMBASE,PubMed,Elsevier,CNKI,Wanfang Database, SinoMed for randomized controlled trial(RCTs) which studied the effects of clinical effects of heated humidified high flow nasal cannula oxygen therapy on post-extubation ICU patients. Two reviewers separately searched the articles, evaluated the quality of the literatures, extracted date according to the inclusion and exclusion criteria. RevMan5.3 was used for Meta-analysis. Results Five RCTs were included involving 982 patients in the study. The Results of meta-analysis showed that the HFNC group was lower than COT group on the re-intubation rate (OR=0.39, 95% CI 0.25-0.62, P<0.05). About oxygenation index, comfort level and toleration of patients, HFNC group was superior to the COT group. Two groups had no significant differences(P>0.05)on post-extubation respiratory failure(OR=0.85,95% CI 0.35-2.09),respiratory infection(OR=0.69,95% CI 0.36-1.34),hospital length of stay(MD=0.51,95%CI-0.02-1.03), mortality of hospital (OR=0.81,95% CI 0.39-1.69). Conclusions The use of HFNC oxygen therapy can reduce there-intubation rate,improve oxygenation index,comfort level and tolerance on post-extubation ICU patients, while HFNC group has no significant impact on the post-extubation respiratory failure, respiratory infection, hospital length of stay, mortality of hospital compared with COTgroup. However, in view of the quantity and quality of study. More RCTs should be conducted to verify the results.

Objective To investigate the current status of emotional labor of ICU nurses and its influence on job burnout.Methods Totally 253 ICU nurses of three comprehensive third-grade class-A hospitals were investigated using the general information questionnaire and nurses' emotional labor scale and job burnout scale.Results The average score of emotional labor was 3.59±0.67.The scores of deep acting,expression of genuine emotion and surface acting were 4.67±0.86,3.37±0.91 and 3.26±0.86.There was a relationship between the factors of emotional labor and job burnout.The surface acting had positive prediction effect on emotional exhaustion(β=0.317,P＜0.01) and depersonalization(β=0.292,P＜0.01),and negative effect on personal achievement (β=-0.144,P＜0.05).Deep acting had negative predictive effect on depersonalization(β=-0.283,P＜0.01) and positive prediction effect on personal accomplishment (β=0.345,P＜0.01).Conclusion ICU nurses have moderate levels of emotional labor,and the deep acting score is the highest between three dimensions.The surface acting and deep acting can predict job burnout,and managers of hospital should pay attention to the education and training of emotional labor for ICU nurses.

Objective To compare the effects of gastric residual volume (GRV) set at different thresholds on intensive care patients receiving enteral nutrition (EN),so as to inform clinical practice.Methods Controlled clinical trials involving different GRV thresholds in ICU patients undergoing EN were retrieved from multiple electronic databases (including Cochrane Library,PubMed,Ovid Medline,Web of Science,CBM,CNKI,Wanfang Data,and VIP).Quality of the retrieved studies was evaluated for data extraction,and meta-analysis was performed.Results Four randomized controlled trials and one clinically controlled trial were included in the study,with a total of 658 subjects.Results of the meta-analysis suggested no statistically significant difference between the group with GRV threshold≥250 ml and the one with GRV threshold＜250 ml in the rates of pneumonia (OR =1.19,95％ CI =0.77-1.82,P =0.43),aspiration.(OR =1.59,95％ CI =0.42-6.03,P=0.50),vomiting (OR=1.35,95％ CI=0.48-3.80,P=0.57),reflux (OR=1.29,95％ CI=0.58-2.88,P=0.53),and diarrhea (OR=1.36,95％ CI=0.87-2.13,P=0.17).Nutrient intake and several other outcome measures were unable to be included in the meta-analysis for either the scarcity of studies or inconsistency in the measures adopted,and descriptive analysis was therefore employed instead.Conclusion There was no significant difference between the two groups in terms of complications,but the group with GRV threshold≥250 ml had higher intake of EN.

Purpose: Elder self-neglect is a global public health issue and should be taken seriously at large. Nurses,usually working directly with elderly patients, have a better understanding of what factors may causeelder self-neglect. In this qualitative study, we explored the influencing factors of elder self-neglect fromthe perception of nurses in the context of Chinese culture. Methods: Face-to-face, in-depth interviews were conducted from November 2018 to December 2018.Purposive sampling was used. Twenty one participants recruited from eight geriatric wards of a generalhospital located in Wuhan were interviewed. A content analysis of qualitative nature was performed toanalyze the data. Results: Our conceptual model illustrated the findings based on the three themes of the conflict betweenpersonal recognition and social judgment, the choice between current needs and individual beliefs, aswell as the compromise between insufficient abilities and limited resources. Conclusion Nurses together with family members and social workers can help older adults improvetheir awareness of self-neglect to bridge the gap with social judgment, learn to focus on their own needs,as well as seek as much support as possible. Nurses should also respect the autonomy and selfdeterminationof elder self-neglecters because self-neglect is related to older adults' values. Furthermore,larger studies are needed to quantitatively test and refine the model.

Purpose: Elder self-neglect is a global public health issue and should be taken seriously at large. Nurses,usually working directly with elderly patients, have a better understanding of what factors may causeelder self-neglect. In this qualitative study, we explored the influencing factors of elder self-neglect fromthe perception of nurses in the context of Chinese culture. Methods: Face-to-face, in-depth interviews were conducted from November 2018 to December 2018.Purposive sampling was used. Twenty one participants recruited from eight geriatric wards of a generalhospital located in Wuhan were interviewed. A content analysis of qualitative nature was performed toanalyze the data. Results: Our conceptual model illustrated the findings based on the three themes of the conflict betweenpersonal recognition and social judgment, the choice between current needs and individual beliefs, aswell as the compromise between insufficient abilities and limited resources. Conclusion Nurses together with family members and social workers can help older adults improvetheir awareness of self-neglect to bridge the gap with social judgment, learn to focus on their own needs,as well as seek as much support as possible. Nurses should also respect the autonomy and selfdeterminationof elder self-neglecters because self-neglect is related to older adults' values. Furthermore,larger studies are needed to quantitatively test and refine the model.

Objective:To evaluate the ultrasound diagnostic value of portal vein complications after liver transplantation by monitoring changes in portal vein hemodynamic parameters using the color Doppler ultrasound technology and to determine its clinical significance.Methods:The clinical data of 99 patients who underwent liver transplantation at the Organ Transplantation Center of the Affiliated Hospital of Qingdao University from July 2015 to December 2018 were analyzed retrospectively. There were 81 males and 18 females, aged (51±9) years old. These patients were divided into the portal vein complication ( n=23) and the non-portal vein complication ( n=76) groups, based on whether portal vein complications had developed within 2 years after surgery. In addition, 30 healthy volunteers at the Affiliated Hospital of Qingdao University, including 16 males and 14 females, aged (40±14) years old were selected to form the control group. The patients’ morphology of liver was studied using color Doppler ultrasound at days 1, 7, 14, 30, 180, 365 and 730 after liver transplantation, and the maximum portal vein blood flow velocity and portal blood flow were recorded. Results:Compared with the control group, the maximum portal venous flow velocity and portal venous blood flow significantly increased on days 1, 7, 14, 30, and 180 after liver transplantation in the non-portal complication group (all P<0.05). With time, these changes showed a decreasing trend. By day 365 after surgery, the differences between the maximum portal venous flow velocity and the portal venous blood flow between the two groups became not significant ( P>0.05). Of the 23 patients in the portal vein complication group, 9 developed portal vein stenosis (PVS) and 14 portal vein embolism. The 9 patients with PVS had a maximum portal flow velocity of 63.8 (46.0, 78.6) cm/s at 1 month after surgery, and this flow velocity was significantly higher than that in the non-portal complication group [35.0(29.6, 41.8) cm/s, Z=-3.35, P<0.001]. The portal blood flow was 993 (887, 1168) ml/min in the 9 patients with portal vein stenosis at 1 month after surgery, and it was significantly higher than those in the non-portal complication group [811(682, 1 018) ml/min, Z=-2.37, P=0.020]. Conclusions:After liver transplantation, both the portal venous blood flow velocity and the blood flow were at high levels in the early postoperative period and they returned to normal levels with time. Ultrasound dynamic monitoring of portal venous blood flow changes was of clinical significance in diagnosing portal vein stenosis and portal vein embolism after liver transplantation.

Objective? To explore the risk factors of incontinence-associated dermatitis(IAD) in intensive care uni(t ICU) patients, so as to provide evidence for early clinical prevention of IAD. Methods? The relevant literature about IAD in ICU patients were retrieved from multiple electronic databases including Cochrane library, PubMed, Ovid Medline, Web of Science, CBM, CNKI, Wanfang Data and VIP from buiding database to November 2018. The Meta-analysis was performed after searching databases, extracting data and assessing quality of included studies using the software of RevMan 5.3. Results? Finally, 14 articles were included with totally 691 case groups, and 1 377 cases in the control group with 2 068 subjects, the incidence of IAD was 20.00%-50.00%. The results of Meta-analysis indicated that feve[r OR=1.79, 95%CI (1.43-2.26), P＜0.05], diabetes[OR=2.73, 95%C(I 1.77-4.21), P＜0.05], the use of antibiotics[OR=2.45, 95%C(I 1.71-3.53), P＜ 0.05], level of albumin[OR=-3.81, 95%C(I -4.61- -3.00), P＜ 0.05], Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ) score[OR=1.70, 95%C(I 0.06-3.33), P＜0.05], fecal incontinence[OR=1.80, 95%C(I 1.07-3.03), P＜ 0.05], incontinence frequency (＞ 3 times/day) [OR=1.86, 95%CI(1.56-2.22), P＜ 0.05]and watery stoo[l OR=2.22, 95%CI(1.81-2.73), P＜0.05]significantly associated with the onset of IAD. Through the sensitivity analysis of the combined effect of the fixed effect model and the random effect model, it was found that the combined effect values were close, indicating that the analysis results were robust and credible. Conclusions? According to the present evidence, the risk factors of IAD in ICU patients are fever, diabetes, antibiotics, low albumin level, high APACHE score, fecal incontinence, incontinence frequency (＞ 3 times/day) and watery stool. Medical staff should pay attention to these risk factors in clinical practice, and actively implement targeted preventive measures to reduce the incidence of IAD in ICU patients and improve the quality of nursing practice.

Objective:To assess the status quo of uncertainty in illness among patients undergoing daytime ophthalmic surgeries and to identify its influencing factors.Methods:Patients who underwent surgery in the Ophthalmic Daytime Surgery Wards of Beijing Tongren Hospital, Capital Medical University, from January to June 2023, were selected by convenience sampling. Data were collected using a general demographic survey and the Medical Uncertainty Inventory Scale (MUIS/MUIS-A). Multiple linear regression analysis was employed to investigate the factors influencing the uncertainty in illness among these patients.Results:Out of 248 questionnaires distributed, 243 were effectively collected, resulting in a 97.98% response rate. The scores on the MUIS/MUIS-A ranged from 55 to 144, with a median of 102. Multiple linear regression analysis indicated that acceptance of the disease, educational level, and the number of surgeries were significant factors influencing the uncertainty in illness among these patients ( P<0.05) . Conclusions:The uncertainty in illness among patients undergoing daytime ophthalmic surgery is above the medium level. Factors such as acceptance of the disease, educational level, and the number of surgeries significantly influence this uncertainty.