Objective To explore the effects of application of the new model of evidence-based land humanized nursing in patients with universal pustular psoriasis.Methods Divided 84 patients with universal pustular psoriasis into the experimental group (42 cases) and the control group (42 cases) randomly.Evidence-based questions were raised according to the requests about humanized nursing of patients in the experimental group,and then retrieved and screened literature,sought high-level evidence,combined with previous nursing experience,developed new evidence-based and humanized nursing programs and implemented in the experimental group.The control group used conventional care program.Two weeks after admission,pain,anxiety,depression degree and the complications of two groups were compared.Results Two weeks after admission,the patients with 0 to 5 levels of pain in the experimental group was 0,5,26,7,4 and 0 cases respectively,which in the control group was0,0,0,12,20 and 10 cases respectively,the difference was significant between the two groups (U=6.957,P＜0.01).Anxiety and depression scores in the experimental group was (41.35±4.30) and (42.55±7.71) respectively,which in the control group was (51.31±4.56) and(50.36±6.89) respectively,the difference were significant between the two groups (t=10.540 and 4.893,P＜0.01).Conclusions The new model of evidence-based and humanized nursing can effectively improve the effects of humanized nursing in patients with universal pustular psoriasis.

Objective To investigate the effects of abdominal breathing training on sleep disorders in elderly patients with chronic heart failure. Methods Total of 100 patients with chronic heart failure complain of sleeping disorders and Pittsburgh Sleep Quality Index (PSQI)>7 points were assigned into two groups by random digits table method, 50 cases in each group. The observation group and the control group were nursed in the same way except that abdominal breathing was adapted to the observation group. Sleep status, heart rate, blood pressure, SpO2 and brain natriuretic peptide (BNP) were evaluated before training, one week and eight weeks after training respectively. Statistics was used to analyze the differences between two groups. Results After training one week, the sleep status of the observation group was ameliorated, but without significant difference compared to the control group (P>0.05). And after training eight weeks, the PSQI, BNP and heart rate were (9.21 ± 6.38) points, (193.78 ± 152.16) μg/L, (63.5 ± 10.8) times/min in the observation group, and (12.92 ± 0.33) points, (417.55 ± 262.47) μg/L, (70.7 ± 8.5) times/min in the control group, and there was significant differences between 2 groups (t=3.627, 2.041, 2.767, all P < 0.05), while the blood pressure, SpO2 did not change obviously(P>0.05). Conclusions Abdominal breathing training could ameliorate sleep status in elderly patients with chronic heart failure.

Objective: To examine the relationship between self-management behaviors and time perspective among patients with comorbid diabetes, so as to provide the evidence for improving self-management behaviors among patients with comorbid diabetes. Methods: The patients with comorbid diabetes who were registered in the chronic disease health management system of Minhang District, Shanghai Municipality in 2021, followed up regularly, and lived in Meilong Town were recruited. Demographic information and family history of diabetes were collected through questionnaire surveys. Time perspective and self-management behaviors were assessed using the Zimbardo Time Perspective Inventory and Diabetes Self-Management Behavior Scale, respectively. The relationship between self-management behaviors and time perspective was analyzed using a multivariable ordinal logistic regression model. Results: A total of 907 patients with comorbid diabetes were enrolled, including 472 males (52.04%) and 435 females (47.96%). There were 652 cases aged 65 years and above, accounting for 71.89%. In terms of the types of time perspective, 280 patients were future-oriented (30.87%), 236 were balanced (26.02%), 162 were sensation-seeking (17.86%), 123 were fatalistic (13.56%), and 106 were negative (11.69%). In terms of the self-management behaviors, 46 patients were good (5.07%), 643 were moderate (70.89%), and 218 were poor (24.04%). Multivariable ordinal logistic regression analysis showed that after adjusting for age, gender, educational level, marital status, occupation status, monthly income, and family history of diabetes, the patients with comorbid diabetes who had a future-oriented time perspective had better self-management behaviors (OR=1.874, 95%CI: 1.204-2.915). Conclusion The self-management behaviors among patients with comorbid diabetes are moderate to poor, and patients with a future-oriented time perspective can better engage in self-management behaviors.

Objective: To study the microstructure development of mandibular bone in rats on timing sequence and under different occlusal force. Methods: 63 male SD rats aged 23 days were randomly divided into three groups (n = 7): Baseline group, soft-diet (SD) group and hard-diet (HD) group. 7 rats were killed at week 0, 2, 4, 6 and 8 respectively after feeding the food with different hardness.Micro-CT was used to reconstruct and analysis microstructure of the region of interest in mandible of the rats. Results: Compared with HD group, bone volume/total volume (BV/TV) and trabecular thickness (Tb. Th) decreased significantly after 4 th week (P ＜ 0. 05), the bone surface/bone volume (BS/BV) and trabecular separation (Tb. Sp) increased significantly during the 4 th to the 6 th week (P ＜0. 05) . Conclusion: In the process of mandibular development in rats, reduction of occlusal force may lead to reduction of bone mass, and the changes of microstructure are closely related to the time of intervention.

Objective To compare the differences in the long-term survival rate and the tumor shrinkage rate of inoperable hepatocellular carcinoma (HCC) between transcatheter arterial chemoembolization (TACE) combined with percutaneous ablation therapy and simple TACE therapy in order to provide the basis for the clinical treatment of HCC.Methods Randomized controlled trials (RCT) for comparing the difference in survival rates between TACE plus PA and simple TACE for inoperable HCC were searched from medical literature database,from which the relevant data were extracted.According to Cochrane manual standard,the quality of inclusion literature was evaluated.Results A total of 15 RCT papers were included in this study,including 859 HCC patients.The results of meta-analysis showed that all the 1-year,2-year and 3-year survival rates in TACE plus PA group were better than those in simple TACE group (RR=1.454,95％CI=1.333and 1.586,Z=8.56,P＜0.001;RR=1.781,95％CI=1.511 and 2.099,Z=6.88,P＜0.001;RR=2.351,95％CI=1.808 and 3.059,Z=6.37,P＜0.001,respectively).The tumor shrinkage rate in TACE plus PA group was also better than that in simple TACE group (RR=1.314,95％CI=1.190 and 1.452,Z=5.38,P＜0.001).The sensitivity analysis indicated that the results of the differences in survival rate and tumor shrinkage rate between the two groups were reliable.Conclusion The 1-year,2-year and 3-year survival rates as well as the tumor shrinkage rate of TACE plus PA group are higher than those of simple TACE group.

Talents constitute key resources for the development of healthcare sector, and studying abroad is an important and effective means for their training. Based on the analysis of the current status of China′s international talents training project of hospitals, this study summarized existing problems in such training. The authors covered such six aspects as lawful standardization of project management methods, selection of trainees by levels and by types, innovation of the process tracking management mechanisms and strengthened full-process assessment, all dimensional institutional support, consolidation of the responsibilities by individual disciplines in talent team building, and measures to cope with the impact of COVID-19. In accordance with the research results, the study analyzed the exploration and practice of the international training project under the " Elite Talents Cultivation Project" of the Affiliated Hospital of Qingdao University, and raised targeted recommendations on attention to the strategic and forward-looking planning, precise setup of training goal categories, classified evaluation of study results, and lawful management among others.

Objective:To explore the related factors of thrombocytopenia (TCP) occurrence in patients with cirrhosis.Methods:A cross-sectional study was conducted. Inpatients with an initial diagnosis of cirrhosis at Peking University First Hospital from January 1, 2010 to December 31, 2020 were included. Clinical data such as demographic characteristics, etiology of cirrhosis, complications of cirrhosis, laboratory indicators, Child-Pugh grade, invasive procedures, and mortality during hospitalization were collected. A logistic regression model was used to explore the related factors of TCP occurrence in patients with cirrhosis. Categorical variables were compared by the χ2 test. The inter-group comparison was performed using continuous variables, a t-test, one-way analysis of variance (ANOVA), or a nonparametric test. Results:There were a total of 2 592 cases of cirrhosis. 75 cases with incomplete clinical data were excluded. 2 517 cases were included for analysis. The median age was 58 (50, 67) years. Males accounted for 64%. 1 435 cases (57.0%) developed TCP, and 434 cases (17.2%) had grade 3-4 TCP. Gender, primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), and concomitant esophagogastric varices (EGV) were the major factors associated with TCP. Females were more prone to combine with TCP ( OR=1.32, 95% CI: 1.12-1.56, P=0.001). Patients combined with EGV ( OR=3.09, 95% CI: 2.63-3.65, P<0.001) were more prone to develop TCP, which was associated with the increased incidence of hypersplenism ( P<0.001). Patients with PBC ( OR=0.64, 95% CI: 0.50-0.82, P<0.001) and PSC ( OR=0.23, 95% CI: 0.06-0.65, P=0.010) were less prone to develop TCP, which was due to the shorter prothrombin time and better coagulation function of PBC patients ( P<0.001), and the lower proportion of hypersplenism in combined PSC patients ( P=0.004). Patients with TCP and grade 3-4 TCP had a higher rate of hemostatic procedures ( P<0.05), but a lower rate of liver biopsy ( P<0.05). Patients with grade 3-4 TCP had a higher nosocomial mortality rate compared to those without ( P=0.004). Conclusion:TCP is common in patients with cirrhosis. However, TCP occurrence is higher in female patients with EGV and lower in patients combined with PBC and PSC. TCP affects invasive procedures and is associated with adverse outcomes.

Objective:To explore the clinical prognoses of acute ischemic stroke (AIS) patients with large core infarction after endovascular therapy (EVT) and their influencing factors.Methods:Totally, 139 AIS patients with large area core infarction (volume of infarction core area≥70 mm3) admitted to our hospital from November 2019 to December 2020 were enrolled in our study; their clinical data were analyz ed retrospectively. These patients were divided into EVT group ( n=78) and non-EVT group ( n=61) according to whether endovascular treatment was performed, and the clinical prognoses of patients from the 2 groups were compared. According to the 3-month modified Rankin scale (mRS) scores, the patients in the EVT group were divided into good prognosis subgroup (mRS scores≤2) and poor prognosis subgroup (mRS scores>2); univariate and multivariate Logistic regressions were used to analyze the independent influencing factors for prognoses of AIS patients with large area core infarction after EVT. Results:As compared with those in the non-EVT group, patients in the EVT group had significantly higher good prognosis rate (11.48% vs. 42.31%), and significantly lower proportion of patients with neurological deterioration, cerebral hernia and death ( P<0.05). As compared with the poor prognosis subgroup, the good prognosis subgroup had significantly lower percentage of patients with atrial fibrillation, significantly higher percentage of conscious patients, significantly higher Alberta stroke program early CT scale (ASPECT) scores, statistically lower volume of infarction core areas, and significantly higher percentage of patients with grading 2-4 in collateral circulation ( P<0.05). ASPECT scores ( OR=4.164, 95%CI: 2.081-8.332, P=0.000), volume of infarction core areas ( OR=0.917, 95%CI: 0.855-0.984, P=0.016), and collateral circulation grading ( OR=5.113, 95%CI: 1.104-23.683, P=0.037) were independent influencing factors for prognoses of AIS patients with large area core infarction after EVT. Conclusion:EVT can effectively improve the prognoses and reduce the complication rate of AIS patients with large area core infarction; patients with high ASPECT scores, low infarct core volume, and high collateral circulation grading get great benefits.

Objective:To clarify the effect and related factors of antiviral therapy on the change of esophageal varices in patients with hepatitis B virus-related cirrhosis.Methods:Fifty-two cases with hepatitis B virus-related cirrhosis who underwent endoscopy before and after antiviral therapy were selected from prospective cohorts. Patients were divided into three groups: no, mild, and moderate-severe based on the degree of esophageal varices. The changes in the severity of esophageal varices in each group were compared after antiviral therapy. Clinical characteristics (platelet, liver and kidney function, liver stiffness, and virological response) of patients with different regressions were analyzed. Measurement data were analyzed by independent sample t-test, one-way ANOVA, Mann-Whitney U test and Kruskal-Wallis H test, and Chi-Square test was used for count data.Results:All patients received entecavir-based antiviral therapy. The median treatment time was 3.1 (2.5-4.4) years. The proportion of patients without esophageal varices increased from 30.8% to 51.9%, the proportion of mild esophageal varices decreased from 40.4% to 30.8%, and the proportion of patients with moderate-to-severe esophageal varices decreased from 28.8% to 17.3% ( χ2=14.067, P=0.001). A total of 40.4% of patients had esophageal varices regression, and 13.5% had esophageal varices progression. The progression rate was significantly higher in patients with moderate-severe esophageal varices than patients with mild and no esophageal varices ( χ2=28.126, P<0.001), and 60.0% of patients with moderate-severe esophageal varices still remained in moderate-severe state after antiviral treatment. Baseline platelet count and 5-year mean change rates were significantly lower in patients with progressive moderate-to-severe esophageal varices than in those without progression (+3.3% vs. +34.1%, Z=7.00, P=0.027). Conclusion:After effective antiviral treatment, 40.4% of patients with hepatitis B virus-related cirrhosis combined with esophageal varices has obtained esophageal varices regression, but those with moderate to severe esophageal varices still have a considerable risk of progression while receiving mono antiviral treatment only. Thrombocytopenia and without significant improving are the clinical signs of progression risk after receiving antiviral treatment.

AIM:This study aimed to investigate the effects of sinomenine hydrochloride(SIN)on the ultra-structure of renal tissue and the expression of interferon gene-stimulating factor in db/db mice.METHODS:Sixteen 12-week-old male db/db mice were randomly divided into two groups:a model group and a sinomenine hydrochloride(SIN)group,each consisting of 8 mice.An additional 8 wild-type(WT)mice served as the normal control group.The sinome-nine hydrochloride group was administered the treatment for 8 weeks,followed by a 20-week observation period,while the normal and model groups received an equal volume of saline via gavage.Weekly measurements were taken for body weight and fasting blood glucose.Serum creatinine(SCr)and blood urea nitrogen(BUN)levels were assessed,and 24-hour uri-nary microalbumin(ALB)levels,as well as serum inflammatory cytokines interleukin-1β(IL-1β),IL-6 and tumor necro-sis factor-α(TNF-α),were determined using ELISA.Pathological changes in renal tissue were evaluated through hema-toxylin-eosin(HE)staining,while ultrastructural alterations were examined using transmission electron microscopy.Im-munohistochemistry and Western blotting were employed to assess STING protein expression in renal tissue,and STING mRNA expression was quantified via RT-qPCR.RESULTS:Compared to the normal group,the model group exhibited significant increases in BUN,ALB,and SCr levels(P<0.01),alongside elevated inflammatory markers IL-1β,IL-6,and TNF-α(P<0.01).Notable pathological changes included leukocyte wall thickening in capillaries,inflammatory cell infiltration,increased mesangial matrix,disorganized and linear alignment of podocytes,and thickening of the basement membrane.Moreover,STING protein and mRNA expression levels were significantly elevated(P<0.01).In contrast,the sinomenine hydrochloride group demonstrated significantly reduced levels of renal function markers(BUN,ALB and SCr)compared to the model group(P<0.01),as well as decreased concentrations of inflammatory factors IL-1β,IL-6,and TNF-α(P<0.01).Improvements in renal histopathology included decreased leukocyte wall thickening,reduced inflam-matory cell presence,diminished mesangial matrix,and a significant reduction in foot process fusion,alongside thinner basement membranes.Both STING protein and mRNA expression levels were also significantly lower(P<0.01).CON-CLUSION:Sinomenine hydrochloride effectively mitigates renal tissue injury,improves ultrastructural alterations,and inhibits inflammatory responses in db/db mice.Its mechanism of action appears closely linked to the downregulation of STING protein and mRNA expression.