Objective To determine if the cardiac index (CI) measured by transesophageal echocardiography (TEE) through the mitral valve (MV) agrees with that measured by transesophageal echocardiography through the ascending aorta (AA).Methods Sixteen ASA Ⅱ or Ⅲ patients (NYHA Ⅱ or Ⅲ),aged 18-70 kg,weighing 46-72 kg,undergoing mitral valve replacement under cardiopulmonary bypass (CPB),were studied.Total intravenous anesthesia was used for induction and maintenance of anesthesia.After tracheal intubation,the TEE probe was placed in the esophagus.CI was measured by transesophageal echocardiography through the MV (CIMV)and AA (CIAA) at 15,30 and 60 min after termination of CPB and recorded.All the data were compared by Bland-Altman analysis.Results CIMV values were significantly lower at each time point than CIAA values (P ＜0.01).The results of Bland-Altman comparison:CIMV 1.29-5.52 L· min-1 · m-2,mean was (2.6 ± 0.9)L·min-1·m-2,and CIAA 2.7-8.8 L·min-1·m-2,mean was (4.9± 1.7) L·min-1 ·m-2,bias was-2.3 L·min-1 ·m-2,and limit of agreement was-5.62-1.03 L· min-1 · m-2 resulting in r =-0.577,P ＜ 0.01.Conclusion CI values obtained through the MV agrees well with that measured through the AA using TEE in patients undergoing mitral valve replacement,but CIAA values are significantly higher than CIMV values,there is a large difference between them for clinical use,and both methods for CI measurement cannot replace each other.

Objective To evaluate the efficiency and safety of exercise interventions on cancer related fatigue. Methods Cochrane Library, JBI Database of Systematic Reviews, MEDLINE, EMbase, CINAHL, Chinese Journal Full- text Database, Chinese Biomedical Literature Database, and Wanfang Databse were searched from the inception to November 2014 to screen the systematic review and Meta-analysis conforming to the inclusion criteria. Two authors independently appraised their methodological qualities with Overview Quality Assessment Questionnaire (OQAQ), and analyzed the data using descriptive analysis. The primary outcome included the scaling of cancer related fatigue, the secondary outcome included adherence to exercise intervention and the incidence of adverse events. Results Fourteen systematic review/Meta-analysis were identified, twelve of them had a high methodological quality (Scoring 5-7). Six systematic review/Meta-analysis found that aerobic exercise could effectively alleviate cancer related fatigue, especially for breast cancer patients;seven articles showed that exercise could modulate cancer related fatigue of patients under active treatments;seven articles reported the compliance to the exercise intervention, four articles reported adverse events occurring during the intervention, very few of them resulted directly from the exercise intervention. Conclusions Exercise intervention can modulate cancer related fatigue with good safety.

Objective To quantitatively analyze the early warning value of laboratory indexes for death risk in children with criti ‐cal hand foot and mouth disease (HFMD) .Methods The univariate and multivariate Logistic regression analysis were conducted to explore the independent risk factors of death in critical HFMD children .Then the area under receiver operating characteristic curve (AUC) was applied to give the comprehensive assessment of the test model ,as well as the early warning capacity and the optimal cut‐off level of laboratory indexes in critical HFMD children .Results The AUC of the Logistic regression model (Y ) established based on white blood cell ,neutrophil ,myoglobin ,creatinine for early predicting the death risk in critical HFMD children patients was 0 .847 (95% CI :0 .783 - 0 .911) ,which indicating that its diagnostic value was superior to single index .Conclusion The diag‐nostic value of the Y model established based on four indexes of white blood cell count ,neutrophile granulocytes count ,myohemo‐globin and creatinine is superior to any single index ,which has the better early warning value for the death risk in children with crit‐ical HFMD .

Objective To explore mechanisms of family resilience in children with obstetrical brachial plexus palsy(OBPP)and provide a basis for developing interventions to family resilience.Methods Semi-structured interviews were conduc-ted with 10 primary caregivers,and data were analyzed through content analysis.Results Three themes were distilled,namely,great impact of the injurious event on the family,positive response of the family to the injurious event,and hidden pain that the injurious event brought to the family.Conclusion The overall resilience of families of OBPP children is in a high level.It is es-sential to address the adverse impact of the injurious event on the families,consolidate the positive results of the family's re-sponse to the injury,and promote the restoration and enhancement of the family's function.

Objective To OxplorO thO OffOct of N-tOrminal pro-brain natriurOtic pOptidO( NT-proBNP) combinOd with nOutrophil to lymphocytO ratio ( NLR) on short -tOrm prognosis in patiOnts with acutO ST sOgmOnt OlOvation myocardial infarction ( STEMI ) undOrgoing primary pOrcutanOous coronary intOrvOntion ( PCI ). Methods From January 2015 to DOcOmbOr 2016, 243 patiOnts with acutO STEMI who undOrwOnt primary PCI in Harrision IntOrnational POacO Hospital wOrO OnrollOd in thO study. ThO lOvOls of NT-proBNP and NLR wOrO mOasurOd at admission. ThO occurrOncO of major advOrsO cardiac and cOrObrovascular OvOnts(MACCE) was followOd up during 1 yOar aftOr PCI. ROcOivOr opOrating charactOristic( ROC) curvOs wOrO usOd to sOt cut-off valuOs of NT-proBNP and NLR for prOdicting MACCE. All patiOnts wOrO dividOd into 4 groups basOd on thO optimal cut-off point: low NT-proBNP/low NLR group, low NT - proBNP/high NLR group, high NT - proBNP/low NLR group, high NT-proBNP/high NLR group. Various indicators wOrO comparOd among thO four groups. Survival curvOs of thO 4 groups at 12 months wOrO constructOd by Kaplan -MOiOr analysis and comparOd using thO log -rank tOst. ThO prOdictivO valuO of NT-proBNP and NLR alonO or in combination for MACCE aftOr PCI was OvaluatOd by thO Cox proportional hazard modOl. Results ThOrO wOrO statistically significant diffOrOncOs in TC,LDL-C, blood glucosO, glycosylatOd hOmoglobin, FMC to Ballon timO, NT-proBNP, NRL among thO high NT-proBNP/high NLR group and thO othOr thrOO groups(F =40.684,65.429,398.62,41.330,217.218,331.5,393.02,all P <0.05). ROC analysis indicatOd thO optimal cut-off point of NT-proBNP, NLR for prOdicting MACCE wOrO 1 600 ng/L(thO arOa undOr thO ROC curvO 0.779,sOnsitivity 81.4% ,spOcificity 83.5% ) and 6.5(thO arOa undOr thO ROC curvO 0.742, sOnsitivity 78.6% ,spOcificity 80.8% ),rOspOctivOly.ThO patiOnts in thO high NT-proBNP(>1 600ng/L) and high NLR(>6.5) group had significantly highOr risk of cardiovascular dOath(23.5% ),hOart failurO(47.1% ),rOcurrOnt MI(17.6% ),and cOrObral strokO(11.7% ),but no significantly incrOasO in thO risk of non-plan rOpOat rOvascular-ization, stOnt thrombosis.ThO survival ratO in high NT -proBNP and high NLR group(76.5% ) was significantly lowOr than thO othOr thrOO groups(98.1% ,97.9% ,95.0% ,χ2 =20.626,P<0.05).MultivariatO analysis of COX proportional hazards modOl showOd that TC, LDL - C, blood glucosO, glycosylatOd hOmoglobin, thO onsOt timO, NT-proBNP, NRL could bO usOd as thO prognostic factors for cardiac and cOrObrovascular OvOnts. ThO prOdictivO powOr of NT-proBNP combinOd with NLR was highOr than OithOr NT-proBNP or NLR alonO.Conclusion IncrOasOd lOvOls of NT -proBNP and NLR at admission could prOdict cardiovascular dOath, hOart failurO, rOcurrOnt MI and cOrObral strokO in patiOnts with STEMI aftOr primary PCI. ThO prognostic capability of intOrgratOd application of NT-proBNP and NLR is bOttOr than OithOr NT-proBNP or NLR alonO.

OBJECTIVE:To observe therapeutic efficacy and safety of Shensong yangxin capsules combined with edaravone in the treatment of cerebrovascular disease complicated with cerebrocardiac syndrome(CCS). METHODS:A total of 128 cerebrovas-cular disease patients with CCS were randomly divided into control group (64 cases) and observation group (64 cases). Control group received routine treatment,observation group was additionally given Shensong yangxin capsule 1.6 g orally,3 times a day+Edaravone injection 30 mg added into 0.9% Sodium chloride solution 250 mL intravenously,2 times a day. Treatment courses of 2 groups lasted for 10 d. Clinical efficacies of 2 groups were observed,and MDA,SOD,catecholamine(NE,E,DA)levels,cT-nI,NIHSS scores,correlation of cTnI level with NIHSS score were also observed before and after treatment. The occurrence of ADR was recorded. RESULTS:Total response rate of nervous system and electrocardio gram in observation group were significant-ly higher than control group,with statistical significance (P<0.05). Before treatment,there was no statistical significance in MDA,SOD,NE,E,DA,cTnI levels or NIHSS scores between 2 groups(P>0.05). After treatment,MDA,NE,E,DA,cTnI levels and NIHSS scores of 2 groups were significantly lower than before,and the observation group was significantly lower than the control group;SOD of 2 groups were significantly higher than before,and the observation group was significantly higher than the antrol group,with statistical significance (P<0.05). cTnI level was positively correlated with NIHSS score (r=0.956,P=0.001). There was no statistical significance in the incidence of ADR between 2 groups(P>0.05). CONCLUSIONS:Based on rou-tine treatment,Shensong yangxin capsules combined with edaravone can significantly improve therapeutic efficacy of cerebrovascu-lar disease patients with CCS,and improve the levels of catecholamine,MDA and SOD without increasing the occurrence of ADR.

Objective To investigate the clinical significance and serum changes of asprosin(ASP)levels in patients with essential hypertension and early renal damage.Methods According to urinary albumin/creatinine ratio(UACR),160 patients with essential hypertension were divided into the simple hypertension group(78 cases)and the early renal damage group(82 cases).Another 60 healthy subjects were selected as the control group.The differences of serum ASP,interleukin-6(IL-6)and UACR levels were compared between groups.The correlation between ASP and blood pressure,IL-6 and UACR was analyzed.Logistic regression analysis was used to analyze the factors influencing early renal damage in essential hypertension.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of each index for early renal injury.Results The serum levels of ASP,IL-6 and UACR were higher in the early renal damage group than those in the control group and the simple hypertension group(all P＜0.05).The serum levels of ASP and IL-6 showed an increasing trend with the increase of blood pressure.ASP was positively correlated with systolic blood pressure(SBP),diastolic blood pressure(DBP)and IL-6 levels in patients with essential hypertension(all P＜0.05).Serum ASP was positively correlated with SBP,UACR and IL-6 levels in essential hypertension patients(P＜0.05),and serum ASP was positively correlated with UACR and IL-6 levels in the early renal damage group(P＜0.05).Logistic regression analysis showed that higher levels of SBP,ASP and IL-6 were independent risk factors for early renal damage.ROC curve showed that ASP had the largest area under the curve(AUC)of 0.972(95%CI:0.950-0.993).The AUC of combined detection of ASP+IL-6+SBP was 0.986(95%CI:0.972-0.999).Conclusion The increased serum ASP level in patients with early renal damage in essential hypertension is a good predictor of early renal damage.The combined detection of ASP+IL-6+SBP is better than single detection.

Objective To evaluate the scientificity,transparency and applicability of Chinese guidelines and expert consensuses on nursing published in 2022,in order to improve the quality of guidelines and consensuses.Methods Databases including Medline,Embase,Web of Science,CBM,CNKI,WanFang database,Chinese Medical Journal,and related websites were electronically searched,as well as China Hong Kong,Macao and Taiwan medical journals,to collect Chinese guidelines and expert consensuses on nursing from January to December 2022.STAR tool was used to evaluate the quality of each guidelines and consensuses by 3 assessors independently.Total score,scoring rate of each domain and item were adopted to analyze the outcomes.Results A total of 3 guidelines and 33 expert consensuses were included.The total guidelines and expert consensuses STAR score(33.5±14.3).The quality of guidelines and consensuses was low.The quality of guidelines was moderate with average score of 55.1,and the quality of consensuses was low with average score of 31.5.The included guidelines and consensuses had a highest score rate(52.4％)in the domain of recommendation.Among 39 items of STAR tool,the top 4 items including listing participants and institutions,explaining additional instructions for implementation,describing consensus method,and listing references for recommendations had a high score rate of 100％,83.3％,77.8％,75.0％respectively.However,the items of registration,providing registration information,protocols being searched on public platforms and explaining the role of funding had a low score rate,urgent need for attention and upgrading.Conclusion The overall quality of the Chinese guidelines and expert consensuses on nursing published in 2022 was low.As a medical and nursing practice guidance document,the quality of guidelines and expert consensuses should be improved by encouraging registration,strengthening management of interest conflict,enhancing the rigor of guideline developing process,and expanding the dissemination.

Objective To observe the effects of Guanxinning tablet on atherosclerotic plaque,renal function,hemorheology,blood homocysteine(Hcy)and immunoinflammation in patients with blood stasis type chronic renal failure complicated by hemodialysis and carotid atherosclerosis.Methods According to the diagnosis,inclusion and exclusion criteria,67 patients with blood stasis type chronic renal failure complicated with carotid atherosclerosis and undergoing hemodialysis from Lishui Second People's Hospital and Lishui Hospital of Traditional Chinese Medicine from January 2023 to January 2024 were selected and randomly divided into control group(33 cases)and observation group(34 cases).The control group received routine treatment of chronic renal failure and hemodialysis.In the observation group,Guanxinning tablet was added to the basic treatment,and the levels of carotid atherosclerotic plaque,renal function,hemorheology,blood Hcy and immunoinflammation were detected in both groups before and after treatment.Results There were no significant differences in general information,carotid atherosclerotic plaque,renal function,hemorheology,blood Hcy level and immunoinflammation level between the two groups before treatment(P>0.05).After treatment,the observation group was superior to the control group in reducing carotid plaque,improving carotid intimedia thickening,improving renal function,reducing inflammatory index level and improving immune function(P<0.05),but there was no significant difference in reducing blood Hcy level compared with the control group(P>0.05).Conclusion Guanxinning tablet can improve the chronic inflammation in the body of patients with blood stasis type chronic renal failure combined with hemodialysis and carotid atherosclerosis,reduce blood viscosity,inhibit red blood cell aggregation,thereby improving carotid atherosclerosis,reducing carotid atherosclerotic plaque,improving renal function and improving immune function of patients,but does not reduce blood Hcy level.

Objective To investigate the efficacy and safety of different doses of Rosuvastatin calcium in treating elderly patients with coronary heart disease complicated with hyperlipidemia.Methods A total of 130 patients with coronary heart disease in combination with hyperlipidemia admitted into our hospital from January 2015 to December 2017 were enrolled.They were randomly divided into the control group(with Rosuvastatin calcium 10 mg per day,n=65)and the study group (with Rosuvastatin calcium 20 mg per day,n=65).Clinical efficacy,changes of blood lipid levels and adverse reactions after treatment were compared between the two groups.Results In the study group,25 cases had obvious effects,35 cases had effects and 5 cases had noeffect.In the control group,21 cases with obvious effects,31 cases with effects and 13 cases without effect were found.The total effective rates were 92.3％ in the study group and 80.0％ in control group(x2 =4.127,P =0.042).The blood levels of total cholesterol (TC),triglyceride(TG)and low-density lipoprotein cholesterol (LDL-C) in the study group were decreased in post-vs.pre-treatment,and were lower in treatment group than in control group(all P =0.000).Nausea and vomiting in 1 case,and muscle ache in 1 case were found in the control group.In the study group,2 cases of nausea and vomiting,2 cases of skin rash,1 case of muscle ache,and 2 cases of joint ache were found.The incidences of adverse reactions were 10.8％ and 3.1％ in the study and control group respectively,with no significant difference between the two groups (x2 =2.984,P =0.084).Conclusions The high-dose of Rosuvastatin calcium(20 mg daily)has significant clinical efficacy and improve the blood lipid levels in elderly patients with coronary heart disease complicated with hyperlipidemia,with no significant difference in incidence of adverse reactions between 10 mg daily versus 20 mg daily Rosuvastatin calcium.