Objective To investigate the relationship between chest radiographic changes and clinical manifestations in patients with scrub typhus in Guangdong area.MethodsA total of 148 cases of scrub typhus admitted to First Affiliated Hospital of Ji′nan University,Guangzhou Eighth People′s Hospital and the Second People′s Hospital of Yuebei between 1999 and 2010 was retrospectively reviewed.The patients were divided into two groups based on the findings of the chest X-rays (with or without radiographic abnormalities).Furthermore,the clinical characteristics and prognosis in two groups were compared.The statistical analysis was done using t test,chi-square test or Fisher′s exact test.ResultsChest X-rays showed abnormalities in 66 (44.6％) cases,and the chest X-ray features were diverse.The incidences of cough,severe thrombocytopenia,hypoalbuminemia,shock,acute respiratory failure,jaundice and acute renal failure were all significantly increased in group of patients with chest X-rays abnormalities compared with the other group of patients without chest X-rays abnormalities (χ2 =18.193,6.872,17.138,5.608,4.318,7.982 and 7.932,respectively; all P＜0.05).The hospitalization day was longer in patients with chest X-rays abnormalities compared with the patients without chest X-rays abnormalities,but there was no statistical difference [(11.7±7.1)d vs (9.9±5.0)d,t=1.717; P=0.088)],while the mortality was higher(6.1 ％ vs 0; Fisher′s exact test,P =0.038).Conclusions The clinical manifestations of the patients with scrub typhus are diverse,and the presence of abnormal chest X-rays is shown to be associated with the disease severity.Physicians should have the awareness of scrub typhus to make the diagnosis and treatment properly.

Objective:To explore the application effect of workshop teaching model in standardized operation training of newly recruited nurses.Methods:A total of 124 newly recruited nurses in Xinxiang Central Hospital from May 2015 to August 2019 were selected as research objects by the objective sampling method. A total of 59 newly recruited nurses from May 2015 to August 2017 were set as the control group and 65 newly recruited nurses from September 2017 to August 2019 were set as the experimental group. The control group adopted the traditional teaching method while the experimental group adopted the workshop teaching model. Operation assessment score and satisfaction with teaching quality of newly recruited nurses were compared between two groups.Results:After training, operation assessment score of nurses in the experimental group was (95.68±8.32) , which was higher than (90.07±7.84) of the control group, and the difference was statistically significant ( t=-3.854, P<0.001) . After training, the number of nurses in the experimental group who were satisfied with the teaching style, teachers' attitude, practical ability and content mastery were all higher than those in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Workshop teaching model can improve the operation assessment score and satisfaction with teaching quality of newly recruited nurses, which is worthy of promotion and application.

Objective:To summarize the nursing points of emergency heart transplantation in an elderly patient with fulminant myocarditis and acute myocardial infarction.Methods:Hemorrhage early warning care, cyclic goal-oriented care, rejection and staged care, infection prevention and control care, difficult ventilator weaning care, and individualized rehabilitation care were provided to elderly patient with fulminant myocarditis and acute myocardial infarction after emergency heart transplantation in July 2020 in the First Hospital Affiliated to Zhejiang University and the effects were observed.Results:The patient's heart function recovered well after the transplantation, and no rejection reaction occurred. Before discharge, the patient was clear, active and optimistic, eating on his own, walking 300 meters in 6 minutes, and the vital signs were stable. One month after discharge, the patient was followed up to take care of himself and was in a stable mood.Conclusions:Carrying out bleeding prevention, circulatory care, rejection care, infection prevention and control care, ventilator difficulty weaning care and individualized rehabilitation care for elderly patients with fulminant myocarditis and acute myocardial infarction after emergency heart transplantation are effective means to ensure the success of the operation and the recovery of patients after the operation.

Objective:Exploring the effect of radiofrequency ablation treatment to restore sinus rhythm on the improvement of functional mitral regurgitation (FMR) and cardiac structure in patients with atrial fibrillation combined with moderate or severe FMR, compared with drug therapy alone.Methods:This retrospective cohort study consecutively enrolled patients diagnosed with persistent atrial fibrillation and moderate or severe FMR who were admitted to the Third Affiliated Hospital of Sun Yat-sen University from January 2019 to December 2021. Forty-eight patients who were treated with radiofrequency ablation and maintained sinus rhythm were enrolled in the ablation group, and 63 patients who were treated with medication alone during the same period were in the medicine group. Patients in the ablation group and medicine group were matched in a 1∶1 ratio using a propensity score, and 41 patients were finally included in each of the 2 groups. All patients reexamined echocardiography after 3-month of treatment. The proportion of patients with FMR improvement and the differences in changes of cardiac structural and functional parameters were compared between groups.Results:After propensity score matching, the ablation group was aged (69.3±7.1) years with 21 males (51.2%) and the medicine group was aged (71.3±9.4) years with 21 males (51.2%). The echocardiography after 3-month of treatment showed the rate of FMR improvement was significantly higher in the ablation group than in the medicine group (19 (46.3%) vs. 33 (80.5%), P<0.001), and patients in the ablation group showed a significant decrease in FMR extent (Δmitral regurgitation area: (-1.30±2.64) cm 2 vs. (-3.55±2.50) cm 2, P<0.001), left atrial size (Δleft atrial diameter: (-0.17±3.78) mm vs. (-2.46±4.01) mm, P=0.009) and E/e′ (ΔE/e′:-2.54±7.34 vs.-6.34±7.08, P=0.021) compared with the medicine group. There was also a significant decrease in left ventricular size (Δleft ventricular end diastolic diameter: (-3.12±6.62) mm vs. (-0.73±3.62) mm, P=0.046) and significant increase in left ventricular ejection fraction (Δleft ventricular ejection fraction: (2.73±9.69) % vs. (-0.93±5.41) %, P=0.038) in ablation group. Conclusion:Performing radiofrequency ablation to restore sinus rhythm can effectively reduce the severity of mitral regurgitation and improve left atrial and left ventricular remodeling and cardiac function in patients with atrial fibrillation and FMR.

Objective:To explore the chain mediation effects of psychological resilience and fear of falling on family function and rehabilitation exercise adherence among stroke patients of different genders.Methods:Totally 298 stroke patients from Xinxiang Central Hospital between January and December 2023 were selected by convenience sampling. Participants were assessed using the Family Assessment Device (FAD), Connor-Davidson Resilience Scale (CD-RISC), Fear of Falling Questionnaire-Reversed (FFQ-R), and Exercise Adherence Questionnaire (EAQ). The SPSS PROCESS macro was utilized to test the chain mediation effects.Results:Male stroke patients had higher total FAD scores, communication, and family role dimension scores, total CD-RISC scores, resilience and self-reliance dimension scores, and EAQ scores, including adherence to physical exercise and exercise supervision, compared to female patients ( P<0.05). However, female patients scored higher in emotional response and emotional involvement dimensions of FAD, total FFQ-R, and all dimensions of FFQ-R, as well as adherence to seeking timely advice of EAQ ( P<0.05). Mediation analysis showed that in male stroke patients, family function had no significant direct effect on rehabilitation exercise adherence (95% CI: -0.055 - 0.096), with psychological resilience and fear of falling playing a fully mediating role; the total mediation effect was 0.113, accounting for 84.96% of the total effect. In female stroke patients, family function had a significant direct effect on rehabilitation exercise adherence, with an effect of 0.110, accounting for 42.80% of the total effect. In addition, psychological resilience and fear of falling partially mediated the relationship between family function and rehabilitation exercise adherence, with a total mediation effect of 0.147, accounting for 57.20% of the total effect. Conclusions:The levels of family function, psychological resilience, fear of falling, and rehabilitation exercise adherence, as well as the mechanisms linking these factors, differ by gender in stroke patients. In male stroke patients, psychological resilience and fear of falling fully mediate the relationship between family function and rehabilitation exercise adherence. In female stroke patients, family function influences rehabilitation exercise adherence through both direct effects and the partial mediating effects of psychological resilience and fear of falling.