Clinical decision support system (CDSS) has been developed and integrated into clinical nursing system by building up rules and knowledge base through literature retrieval, expert argumentation, and situation analysis. With such algorithms as reasoning algorithm, case study, artificial intelligence and big data analysis, three modules have been constructed as follows. The first is an Intelligent Knowledge-based Decision Module composed of 15 document-driven knowledge-based decision-makers and 5 task-driven knowledge-based decision-makers. The second is an Intelligent Quality Control Recording Module which has achieved intelligent quality control of nursing records through Feedforward Control and Feedback Control. The third is an Intelligent Human-Computer Interaction Module which consists of real-time static interactions through e-board and dynamic reminders/alarms triggered by the system. CDSS, since in use, has reduced the incidence of adverse nursing events and problems of quality control in nursing records, and improved satisfaction of patients.

Objective:To investigate the effectiveness of balloon-assisted technique for the treatment of intraprocedural aneurysmal rupture (IAR) during intracranial aneurysm coil embolization and its impact on the clinical outcomes of patients.Methods:Patients with intracranial aneurysm received coil embolization and complicated with IAR in Xijing Hospital of Air Force Medical University from January 2013 to January 2019 were enrolled retrospectively. They were divided into balloon-assisted hemostasis group and rapid packing hemostasis group according to the methods of intraoperative hemostasis. The modified Rankin Scale was used to evaluate the clinical outcomes at 3-month postoperative follow-up. A score of 0-2 was defined as a good outcome. Multivariate logistic regression analysis was used to identify the independent influencing factors of clinical outcome. Results:A total of 77 patients with IAR were enrolled, of which 46 (59.74%) used balloon-assisted hemostasis, and 31 (40.26%) used rapid packing hemostasis. In 51 patients (66.23%) with 3-month follow-up data, 32 (62.75%) had good outcomes, and 19 (37.25%) had poor outcomes. Univariate analysis showed that there were significant differences in time from IAR to treatment, time from IAR to confirmed hemostasis, postoperative Fisher grade changes, and good outcomes between the balloon-assisted hemostasis group and the rapid packing hemostasis group (all P<0.05). There were significant differences in IAR treatment methods, time from IAR to treatment, time from IAR to confirmed hemostasis, and postoperative Fisher grade changes between the good outcome group and the poor outcome group (all P<0.05). Multivariate logistic regression analysis showed that balloon-assisted hemostasis (odds ratio 0.234, 95% confidence interval 0.056-0.990; P=0.048) and time from IAR to confirmed hemostasis ≤10 min (odds ratio 0.097, 95% confidence interval 0.024-0.397; P=0.001) were the independent protective factors of the good outcomes in patients with IAR. Conclusion:Using balloon-assisted technique to treat IAR during intracranial aneurysm coil embolization can achieve satisfactory hemostatic effect and improve the clinical outcomes of patients.

Objective:To comprehensively retrieve and summarize the best evidence on the prevention of position-related nerve injury in adult patients undergoing general anesthesia, in order to provide evidence-based guidance for standardized position management during general anesthesia surgery in adults.Methods:Clinical decision-making, guidelines, evidence summaries, best practice, practice advisories, systematic reviews, expert consensuses were systematically search in UpToDate, BMJ Best Practice, Guidelines International Network (GIN), Canadian Medical Association: Clinical Practice Guideline(CMA Infobase), National Guideline Clearinghouse (NGC), National Institute for Health and Care Excellence(NICE), Cochrane Library, PubMed, CNKI, Wanfang, and related websites. The literature retrieval period was from the database construction to September 30,2022. The guidelines were independently assessed by 4 researchers, and the remaining literature was independently evaluated by 2 researchers. The literature that met the criteria was extracted. Finally, the expert meeting integrated the evidence and summarized the evidence topics.Results:A total of 17 articles were included, including 6 clinical decision-making, 3 guidelines, 2 practice advisories,5 systematic reviews, and 1 expert consensus. A total of 32 pieces of best evidence and 5 evidence topics were formed: personnel placement, perioperative evaluation, points of surgical position, key points in special surgery or situation, other general principles.Conclusion:This study summarized the best evidence for the prevention and management of surgical position related nerve injuries, and provides a scientific theoretical reference for postural management of adult patients undergoing operation with general anesthesia, to reduce the incidence of nerve injuries related position.

Objective: To assess left atrial(LA)function by evaluating changes of LA wall movement and volume detected by real-time three-dimensional speckle tracking imaging(RT3D-STI)in elderly patients with ischemic mitral regurgitation(IMR). Methods: Eighty-six elderly patients with coronary heart disease(CHD)were enrolled in this study.According to whether or not to have IMR, the patients were divided into the pure CHD group(n=32)and the CHD-induced ischemic mitral regurgitation(IMR)group(n=54, including 20 cases of mild IMR, 18 cases of moderate IMR and 16 cases of severe IMR). Thirty-two healthy elderly volunteers were considered as control group.RT3D-STI was used to evaluate the global atrial longitudinal strain(GLS), global circumferential strain(GCS), global radial strain(GRS)and LA maximal, minimal and pre-systolic volumes(LAVmax, LAVmin, and LAVp). LA ejection fraction(LAEF), LA passive ejection fraction(LApEF)and LA active ejection fraction(LAaEF)were calculated.The relationship of LA volume changes and myocardial strain with LA function was analyzed. Results: The left ventricular ejection fraction(LVEF)and LAEF were reduced in CHD group and IMR group as compared with the control group, and were lower in IMR group than in CHD group(P<0.05). Compared with the control group, the LAVmin was increased, and the LAaEF was decreased in the IMR group(P<0.05). Compared with the control group, the GLS, GCS, GRS were declined in the CHD and IMR groups, and were lower in IMR group than in control group(P<0.05). Along with the increased severity of regurgitation, GLS, GCS, and GRS were decreased in varying degrees.The standard deviations of time to peak longitudinal strains(TLS-SD), of time to peak circumferential strains(TCS-SD), and of time to peak radial strain(TRS-SD)rose in the IMR group as compared with the control group(P<0.05). The myocardial motion indicators(GLS, GCS, GRS)had a quite strong correlation with LAEF in the CHD and IMR groups(CHD group: r=-0.745, -0.718 and 0.627, P=0.006, 0.007 and 0.009; IMR group: r=-0.785, -0.781, 0.643, P=0.006, 0.007 and 0.008). The receiver operating characteristic(ROC)curves analysis showed that the sensitivity and specificity of TLS-SD, TCS-SD and TRS-SD were 89.7% and 81.8%, 78.6% and 84.8%, 85.7% and 72.1%, respectively in the evaluation of LA function changes. Conclusions RT3D-STI can precisely and objectively assess the LA function changes by measuring the volume changes and tracing the myocardial motion in elderly IMR patients.

Objective To explore the establishment and implementation effects of hierarchical management model of clinical nurse specialists (CNS). Methods The Nanjing Drum Tower Hospital management committee of nursing education implemented hierarchical advancement, hierarchical employment and hierarchical performance incentive to 93 specialty nurses from January to September 2016. The effects of hierarchical management model of CNS were evaluated by nursing quality qualification rate, patient satisfaction and job satisfaction of CNS. Results After the implementation of hierarchical management model of CNS, it showed significant improvement in nursing quality, patient satisfaction in both outpatient department and inpatient department, and job satisfaction of CNS. The difference between before and after the implementation was statistically significant (P<0.05). Conclusions The establishment of hierarchical management model of CNS can improve the nursing quality, patient satisfaction, and job satisfaction of the nurses.

Objective:To discuss the value of real-time three-dimensional speckle tracking imaging(RT3D-STI) in the evaluation of the left atrial (LA) volume and function in end-stage renal disease (ESRD) patients with different dialysis methods.Methods:Eighty-three ESRD patients who were treated in the Affiliated Hospital of Qingdao University from February to August 2019 were enrolled and divided into non-dialysis group ( n=25), hemodialysis group (HD group, n=31) and peritoneal dialysis group (PD group, n=27). And 30 healthy volunteers were enrolled as control group. Subsequently, the LA volume indexs including LA maximal volume index (LAVImax), LA minimal volume index (LAVImin) and LA presystolic volume index (LAVIpre), the LA function parameters including LA ejection fraction (LAEF), LA passive ejection fraction(LApEF) and LA active ejection fraction (LAaEF) and the LA global strain parameters including global longitudinal strain(GLS), global radial strain(GRS) and global circumferential strain(GCS) were obtained by RT3D-STI. The differences of the parameters among these groups were compared and the correlations between the myocardial strain parameters and dialysis time were analyzed. Results:①The LAVImax, LAVImin and LAVIpre of the non-dialysis group, PD group and HD group were higher than those in the control group, while the LAEF, LApEF, GLS, GRS and GCS were lower than those in the control group(all P<0.05); the LAVImin of the PD group as well as the LAVImin, LAVIpre and LAVImax of HD group were higher than those of non-dialysis group, while the LAEF, LApEF, GLS, GCS of the PD group and the LAEF, LApEF, GLS, GRS, GCS of HD group were lower than those of non-dialysis group (all P<0.05). The LAVImax, LAVImin, LAVIpre of HD group were higher than those of PD group, while the LAEF, LApEF, GLS, GRS and GCS of HD group were lower than those of PD group (all P<0.05). ②The GLS and GCS in PD group were negatively correlated with the dialysis time( r=-0.670, -0.596, all P<0.05), and the GLS, GCS and GRS in HD group were negatively correlated with the dialysis time( r=-0.624, -0.631, -0.551, all P<0.05). Conclusions:RT3D-STI can assess the LA volume and function of ESRD patients with different dialysis methods effectively and can further evaluate the prognosis of patients and guide timely clinical intervention.

Objective: To study the fatigue symptoms of adult patients with primary immune thrombocytopenia (ITP) and to analyze the possible factors that affect the severity of fatigue. Methods: Eligible adult patients with ITP who admitted to Institute of Hematology & Blood Diseases Hospital were enrolled in this study and the questionnaires including a Chinese version of the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) , the Pittsburgh sleep quality index (PSQI) , the Hospital Anxiety and Depression scale (HADS) and demographic information were completed. The predictors of fatigue were determined with multiple linear regression analyses. Results: A total of 207 patients with ITP were enrolled, including 70 males (33.8%) and 137 females (66.2%) , the median age was 42 (18-72) years old. The FACIT-F score in ITP patients was (37.50±9.05) . The FACIT-F severity of ITP patients was positively correlated with the platelet count (r=0.307, P<0.001) . The FACIT-F severity was negatively correlated with bleeding severity (r=-0.276, P<0.001) , sleep quality (r=-0.654, P<0.001) , depression (r=-0.598, P<0.001) and anxiety (r=-0.616, P<0.001) . A multiple linear regression analysis revealed that the severity of ITP-related fatigue was significantly correlated with platelet count (P<0.001) , bleeding severity (P=0.004) , sleep quality (P<0.001) and depression (P<0.001) . Conclusion Fatigue was determined by complicated factors in adult ITP patients. Interventions addressing depressive symptoms, sleep quality, bleeding symptoms and platelet count could be potential avenues for treatment of fatigue in patients with ITP.

The clinical data, laboratory testing, genetic testing results, diagnosis and treatment process of a child with PERCHING syndrome diagnosed and treated in the Department of Neonatology, the Third Affiliated Hospital of Zhengzhou University in June 2022 were retrospectively analyzed, and the relevant literatures were reviewed.The proband mainly presented with dyspnea and feeding difficulties after delivery, facial nevus flammeus, protrusion of eyes, small fissure of eyes, wide nasal root, limited opening of mouth, slightly high palatal arch, special posture, cryptorchid, hypospadias, and high muscle tone of limbs.Magnetic resonance imaging of the brain suggested possible agenesis of corpus callosum.Genetic testing showed complex heterozygous variations in the KLHL7 gene, and the two mutation sites have not been previously reported.A case of PERCHING syndrome caused by the KLHL7 gene mutation in China was reported for the first time, which provided new ideas for the diagnosis and treatment of children with PERCHING syndrome and reliable genetic evidence for family reproduction.

As research delves deeper into the mechanisms of tumor immune responses,studies reveal the importance of microbial com-munities within the tumor microenvironment in tumor progression and their interactions with the host immune system.Intratumoral micro-biota could influence the tumor microenvironment,thereby promoting or inhibiting tumor growth and development.Despite this import-ance,the specific role of intratumoral microbiota impacting cancer immunotherapeutic efficacy remains largely unexplored.A deeper under-standing of the characteristics and biological functions of tumor-specific microbiota heralds a potential revolutionary innovation in cancer treatment.In this review,we introduce the discovery and sources of intratumoral microbiota,also addressing its composition,and discuss tumor tissue characteristics.Moreover,we briefly review the history of cancer immunotherapy development with a particular focus on the research progress concerning the impact of intratumoral microbiota on cancer immunotherapy.Furthermore,we explore emerging strategies that combine targeting intratumoral microbiota with immunotherapy to enhance immune efficacy,inhibit tumor progression,and improve cure rates,anticipating that this approach could represent a new direction for enhancing treatment outcomes and prospects.

OBJECTIVETo deepen the understanding of clinical manifestations and treatment of patients with positive lupus anticoagulant (LAC).

METHODSThe clinical data of 2 patients were analyzed and related literature were reviewed.

RESULTSCase 1, a 31-year-old female, diagnosed as lupus anticoagulant positive, secondary to undifferentiated connective tissue disease, was presented with menorrhagia and thrombocytopenia. Anti-nuclear antibody (ANA) was positive 1:1000 (homogeneous type) with anti-double stranded DNA positive, and dRVVT LA1/LA2 was 3.4. Coagulation function was alleviated after treatment with glucocorticoid and total glucosides of paeony. Case 2, a 59-year-old female was presented with gingival bleeding, hematuria with the level of F II:C 13%. dRVVT LA1/LA2 was 2.0. Anti-nuclear antibody (ANA) was positive 1:1000 (type of cytoplasmic granule), anti-double stranded DNA was positive. The patient was diagnosed as hypoprothrombinemia-lupus anticoagulant syndrome (LAHS) and acquired coagulation factor deficiency. The signs of hemorrhage were alleviated after treatment with methylprednisolone 40 mg/day and cyclophosphamide, while the level of F II:C was below normal.

CONCLUSIONSymptoms of patients with positive LAC are variable. The diagnosis relies on history of disease and laboratory test. Currently, there is no standardized treatment. Cases of LAHS should be thoroughly investigated for any known causes and related disorder.

Adult ; Blood Coagulation ; Cyclophosphamide ; therapeutic use ; Female ; Glucocorticoids ; therapeutic use ; Hematologic Tests ; Hemorrhage ; Humans ; Hypoprothrombinemias ; diagnosis ; Lupus Coagulation Inhibitor ; blood ; Methylprednisolone ; therapeutic use ; Middle Aged