Objective Mechanical ventilation is an important life support treatment in ICU, however, patients are at high risk for ventilator?associated pneumonia(VAP) and other complications which can increase the risk of death. In the article, comparative investigation was made on ventilation effects of different degrees of semirecumbent positions and preventive effects of VAP and pressure ulcers in order to provide evidence for preferred position. Methods 46 patients were divided into 30° group and 45° group in halves according to the angle of semirecumbent position. Patient position changes were performed among semirecumbent, right and left laterally inclined positions every two hours in both groups for consecutive 7 days. The peak airway pressure (PAP) and minute ventilation (MV) changes were measured every half an hour in two hours after semire?cumbent positioning every day during ventilation. The pressure of arte?rial oxygen(PaO2), pressure of arterial carbenoxide (PaCO2) and PaO2/FiO2(fraction of inspired oxygen,FiO2) were tested every day during intervention, along with the observation on the incidence of VAP and pressure ulcers. Results MV at each time point was normal in two hours after semirecumbent positioning in both groups with no changes to prolonged time ( P<0.05) . PAP increased with the prolonged time at each time point, which was higher in 45° group compared with 30°group(P<0.05). No significant difference was found in the incidence of VAP and pressure ulcers between two groups (P>0.05). Conclusion Both 45° and 30°semirecumbent po?sitions can be applied in ventilated patients and the patient′s medical condition and tolerance are the keys when choosing preferred posi?tion and duration.

Objective:To analyze the effect of different hepatitis B virus DNA (HBV DNA) loading on liver function in patients with hepatitis B-related hepatocellular carcinoma (HCC).Methods:From February 2017 to August 2018, 78 patients with HCC who underwent radical hepatectomy in the Second Affiliated Hospital of Guangxi University of Science and Technology were enrolled retrospectively.According to the difference of preoperative serum HBV DNA load, there were 30 cases in the high copy group and 48 cases in the low copy group.The positive rates of HBV DNA load in patients with hepatocellular carcinoma were compared 3 days before operation, 7 days and 6 months after operation.Repeated measurement ANOVA was used to observe the liver function of the two groups 3 days before operation, 7 days and 6 months after operation, and the adverse reactions of the two groups were compared.Results:There was no significant difference in the positive rate of HBV DNA load between 3 days before operation, 7 days after operation and 6 months after operation ( P>0.05). The levels of alanine aminotransferase in high copy group were (60.25±28.22), (201.35±69.12), (250.52±74.76) U/L 3 days before operation, 7 days and 6 months after operation, and those in low copy group were (57.24±20.83), (144.50±49.25), (200.21±51.66) U/L.The results of repeated measurement ANOVA showed that Fintra-group=20.429, P<0.01, Finter-group=7.119, P<0.01, Finteraction=27.547, P<0.01.There were significant differences between 7 days, 6 months and 3 days before operation (all P<0.01), between 7 days and 6 months after operation (all P<0.05), and between 7 days and 6 months after operation (all P<0.05). The aspartate aminotransferase levels were (53.14±24.23), (300.30±63.85), (352.36±60.38) U/L in the high copy group 3 days before operation, 7 days and 6 months after operation, and (57.74±23.13), (232.56±53.08), (254.56±58.78) U/L in the low copy group.The results of repeated measurement ANOVA showed that Fintra-group=41.476, P<0.01, Finter-group=50.211, P<0.01, Finteraction=8.736, P<0.01.The difference between 7 days and 6 months after operation and 3 days before operation within the group was statistically significant (all P<0.01). The difference between 7 days after operation and 6 months after operation was statistically significant (all P<0.05). There were statistically significant differences between the groups at 7 days and 6 months after operation (all P<0.05). The plasma albumin of high copy group was (38.13±13.14), (24.22±8.56), (20.31±5.37) g/L 3 days before operation, 7 days and 6 months after operation, and that of low copy group was (37.93±12.54), (29.77±9.32), (25.32±6.43) g/L.The results of repeated measurement ANOVA showed that Fintra-group=12.836, P<0.01, Finter-group=3.608, P<0.05, Finteraction=16.444, P<0.01.There were significant differences between 7 days, 6 months and 3 days before operation (all P<0.01), between 7 days and 6 months after operation (all P<0.05), and between 7 days and 6 months after operation (all P<0.05). The total bilirubin of high copy group was (27.56±6.12), (37.78±9.45), and (46.56±10.22)% at 3 days before surgery, 7 days and 6 months after surgery, and that of low copy group was (25.82±6.38), (31.11±8.65), (38.26±9.23)%, respectively.The results of repeated measurement ANOVA showed that Fintra-group=10.281, P<0.01, Finter-group=8.832, P<0.01, Finteraction=19.114, P<0.01.There were significant differences between 7 days, 6 months and 3 days before operation (all P<0.01), between 7 days and 6 months after operation (all P<0.05), and between 7 days and 6 months after operation (all P<0.05). In addition, the recovery time of liver function in the high copy group was (13.22±2.21) d, and that in the low copy group was (10.34±2.53) d. The difference between the two groups was statistically significant ( t=5.128, P<0.01). The incidence of adverse reactions was 46.67% (14/30) in the high copy group and 16.67% (8/48) in the low copy group, and the difference was statistically significant ( P=0.008). Conclusion:There was no significant change of HBV DNA load in HCC patients before and after operation, while the recovery ability of liver function in HCC patients with high copy HBV DNA was significantly reduced, the incidence of adverse reactions was higher, and the prognosis was poor.

Objective To study the effect of transcatheter arterial chemoembolization(TACE) combined with three-dimensional conformal radiotherapy(3DCRT) for inoperable primary liver cancer.Methods Ninety-six such patients were prospectively randomized to TACE therapy alone group(TACE group-,47 patients) and TACE+3DCRT group(combined group-,49 patients).Results The overall 1-,2-,3-year survival rate was 82%,63%,43% in the combined group.It was 55%,28%,15% in the TACE group.The difference between the two groups was significant(P0.05).Conclusion Transcatheter arterial chemoembolization combined with three-dimensional conformal radiotherapy is more effective than transcatheter arterial chemoembolization therapy alone for inoperable primary liver cancer,without inflicting more treatment-related toxicities.

Objective To analyze the dynamic changes of immunoregulatory factors and tumor markers before and after chemotherapy in patients with advanced gastric cancer.Methods From October 2015 to February 2018,58 patients with chemotherapy AGC in our hospital were selected as gastric cancer group.According to the efficacy of chemotherapy they were divided into effective group, stable group and ineffective group.Meanwhile,30 healthy persons were selected as normal group.The immunoglobulins (IgA, IgG,IgM), T lymphocyte subsets ( CD3+, CD4+, CD8+, CD4+／CD8+) and related tumor markers ( CEA, CA199,CA242) were compared before and after chemotherapy.Results The levels of IgA((2.11±0.89) g／L),IgM((10.65±4.61) g／L),IgG((1.25±0.45) g／L),CD8+((28.12±3.56)%),CEA((40.33 ±16.24) μg／L),CA199((76.34±21.56) kU／L) and CA242((29.34±9.57)k U／L) in the gastric cancer group were significantly higher than those in the normal group IgA((0.93±0.36) g／L),IgM((6.46±3.59) g／L),IgG((0.65±0.32) g／L),CD8+(( 25.02± 4.78)%),CEA((1.81± 0.55) μg／L),CA199((7.51 ±2.67) kU／L),CA242((3.35±1.21) kU／L) (t＝6.958,3.600,6.495,3.435,12.952,17.370,14.773, P＜0.05),while CD3+(( 64.12± 5.12)%),CD4+(( 34.12 ± 4.10)%),CD4+／CD8+( 1.09 ± 0.28) were lower than the normal group (CD3+(71.23±7.14)%,CD4+( 39.78±5.20)%,CD4+／CD8+( 1.47±0.40)) (t＝5.376,5.592,5.192,P＜0.05).The total effective rate of AGC patients in gastric cancer group was 79.31 %(46／58),and the ineffective rate was 20.69%(12／58).IgA,IgG,IgM,and CD8+in the effective group were significantly lower than those before chemotherapy (t＝3.925,3.745,4.036,2.661,P＜0.05), while CD3+,CD4+, CD4+／CD8+ were significantly higher than before chemotherapy ( t＝3.520, 3.077, 3.218,P＜0.05).The subcellular level of protein and T lymphocytes was significantly better than that of stable group and ineffective group (P＜0.05).The levels of tumor markers CEA,CA199 and CA242 in the effective group and stable group were significantly lower than those before chemotherapy ( P＜0.05), and significantly lower than the ineffective group ( P＜0.05).Conclusion The levels of immunoglobulins, T lymphocyte subsets and tumor markers in patients with AGC have significant changes after chemotherapy,and their levels can guide the efficacy of chemotherapy.

Objective To evaluate the wound healing efficacy of negative pressure wound therapy (NPWT) combined with topical oxygen therapy ( TOT ) on the traumatic chronic wounds , and to explore new conception and method for traumatic chronic wounds . Methods Sixty-four patients with traumatic chronic wounds were randomized into two groups ( n=32 ) .Patients in the control group were treated by NPWT , and those in the intervention group were treated by NPWT and NPWT with TOT 3L/min.The treatment time lasted 12 days, and the dressing and tubes were changed every three days in the two groups .After 12 days, all the pa-tients were treated by standard moist therapy or surgery until healing or three months .Indicators of observation: The pressure ulcer scale for healing (PUSH) scores and granulation covered rate at 0, 3, 6, 9, and 12 days were measured, and healing rate and healing time during three months were calculated in the two groups . Results The PUSH scores were declined with intervention time during 12 days in the two groups , indicating the treatment was effective , but there was no significant difference between the two groups ( P>0 .05 ) .The granulation covered rate was increased with intervention time , and the granulation covered rate was higher in the intervention group than in the control group(P<0.001).The healing rate was higher in the intervention group than in the control group (87.50%vs 59.38%, P<0.05 ).The healing time of 14 days was shortened in the intervention group compared with the control group (P<0.001). Conclusion NPWT combined with TOT is an effective and feasible method for complicated traumatic chronic wounds , which can en-hance granulation growth , rise healing rate and shorten healing time .

Objective To compare various CT signs of pancreatic carcinoma (PC) and inflammatory pancreatic mass (IPM), and to study the diagnostic value of these signs for distinguishing two diseases. Methods Eigty-five patients with PC and IPM were proved by surgery, fine needle aspiration or other comprehensive methods. These patients underwent non-enhanced and enhanced CT scans. CT findings were analyzed retrospectively. The occurrance rates of various CT signs in these two diseases were analyzed with Fisher test and were compared with the corresponding clinical and operational results as welL Results Among the 85 patients, 66 patients were proved to have PC, and 19 were proved to have IPM. In PC group,58 were corerectly diagnosed with CT, 3 (4. 5% ) were misdiagnosed, and 5 (7.6%) were omitted. In IPM group, 9 were correctly diagnosed with CT and 10 (52. 6% ) were misdiagnosed. The CT findings were as follows: (1) Pancreatic mass with liver metastases, lymph node metastases, encased celiac arteries, and cancer emboli in portal veins just occurred in PC group. (2) The occurrence rates of mass over 3 cm in diameter, clear boundary, low-density area within the mass, pseudocysts, peripancreatie infiltration, ascites, and slight and moderate pancreatic-bile duct dilation in PC group were 90. 91% (60/66), 15.15% ( 10/66), 54. 55% ( 36/66 ), 10. 61% ( 7/66 ), 4. 55% ( 3/66 ), 22. 73% ( 15/66 ), 24. 24% ( 16/66 ), 45.45% (30/66), and 27. 27% (18/66) respectively, the occurrence rates in IPM group were 94. 74% ( 18/19), 15.79% ( 3/19 ), 52. 63% ( 10/19 ), 15.79% ( 3/19 ), 15. 79% ( 3/19 ), 21.05% (4/19), 31.58% (6/19) ,21.05% (4/19), and 5.26% (1/19) respectively. There was no statistical difference for these CT findings between two groups(P >0. 05). (3) Pancreatic head mass with atrophy of pancreatic body and tail, mass calcification, pancreatic duct-penetrating sign, pancreatic head mass with hypertrophy of pancreatic body and tail, biliary stones with inflammation , and thickening of pre-kidney fascia in PC group were 48.48% ( 32/66 ), 3.03% ( 2/66 ), 1.52% ( 1/66 ), 10. 61% ( 7/66 ), 6. 06% ( 4/66 ) and 3.03% (2/66) respectively, the occurrence rates of those in IPM group were 5. 26% (1/19),47.37% (9/19), 15.79% ( 3/19 ), 84. 21% ( 16/19 ), 36. 84% ( 7/19 ) and 21.05% ( 4/19 ) respectively. There was statistical difference for these CT findings between two groups ( P < 0. 05 ) . Conclusion Accurate evaluation of various CT signs in PC and IPM is of great importance in the diagnosis of the two diseases.

Objective The incidence rate of pressure ulcer is high in critical patients and off-loading mattresses and reposi-tioning are known as effective interventions for the prevention of pressure ulcers .However, evidence is lacking for selection of the right type of mattresses and suitable interval of repositioning .This study was to compare the effects of two types of off-loading mattresses with two different repositioning intervals in preventing pressure ulcers in critical patients . Methods According to the design of this ran-domized controlled trial , we made a training plan concerning the participants , methods of intervention and comparison , criteria and methods of observation , and methods of recording , and trained 26 nurses from 7 hospitals .Using non-inferiority design and the method of stratified blocked randomization , we divided 1194 patients with the risk of pressure ulcer into a trial group ( n=596) and a control group ( n=598) , a viscoelastic sponge mattress with every-four-hours repositioning used for the former and an automatic aeration mat-tress with every-two-hours repositioning for the latter , both for 7 successive days .We examined the patients every day , recorded the in-cidence and stages of pressure ulcer , and compared the data obtained between the two groups of patients . Results The total inci-dence rate of pressure ulcer was 1.09%(13/1194), significantly lower in the trial than in the control group (0.34%[2/596] vs 1.84%[11/598], P=0.012). Conclusion A viscoelastic sponge mattress with every-four-hours repositioning is superior to an automatic aeration mattress with every-two-hours repositioning and therefore is preferred to the latter in preventing the incidence of pressure ulcer in critical patients in the ICU .

Objective:To understand the current status of existential distress in patients with advanced lung cancer and analyze its influencing factors, so as to provide a reference for developing targeted intervention programs.Methods:A total of 320 patients with advanced lung cancer were selected using convenience sampling from two Class Ⅲ Grade A hospitals in Weifang between February 2022 and August 2023. The data were collected using a General Information Questionnaire, the Chinese Version of the Existential Distress Scale (EDS), the Social Support Revalued Scale (SSRS), the Chinese Version of the Strategies Used by People to Promote Health (SUPPH), and Patient Health Questionnaire-9 (PHQ-9). Spearman correlation analysis was conducted to analyze the relationships between EDS, SSRS, SUPPH, and PHQ-9 scores, and multiple linear regression analysis was used to identify the influencing factors of existential distress in patients with advanced lung cancer. A total of 320 questionnaires were distributed, with 318 valid responses, yielding a valid response rate of 99.38% (318/320) .Results:The total EDS score for the 318 patients was 3.00 (2.00, 4.00). EDS scores were positively correlated with PHQ-9 scores and negatively correlated with SSRS and SUPPH scores ( P<0.01). Multiple linear regression analysis showed that marital status, social support, self-management efficacy, and depression were influencing factors of existential distress in patients with advanced lung cancer ( P<0.05) . Conclusions:Patients with advanced lung cancer experience mild existential distress. Medical staff should assess existential distress levels, paying close attention to patients who are divorced or widowed, have low levels of social support and self-management efficacy, or are experiencing depression. Early interventions should be developed to alleviate negative emotions and help patients rebuild their sense of meaning, thereby improving psychological well-being and reducing survival distress.

Objective:To investigate the clinical characteristics of psoriasis and status quo of medical care for patients in county areas of China.Methods:This study was a cross-sectional investigation. Based on the “Qianxian Wuyin” Project (a national project for upgrating ability for psoriasis care at county level), an online questionnaire survey was conducted in the dermatology departments of 459 county hospitals in 404 pilot administrative counties across China from February to June 2023. The questionnaire included demographic information of patients (gender, ethnicity, age, place of residence, education, marital status), and clinical characteristics of psoriasis (disease course, type, comorbidities, body surface area (BSA) and previous treatment. The Dermatology Life Quality Index (DLQI) and Psoriasis Area and Severity Index (PASI) were applied for assessing the quality of life and disease severity, and completed by patients or guardian and doctors, respectively.Results:A total of 16 935 patients completed the questionnaire. The age of patients was 1-102(44.17±11.58)years, and 71.0% (12 036/16 935) were 30-59 years old. The ratio of male to female was 2.21∶1; 24.3%(4 117/16 935) of patients had high school education; there were 9 940 patients(58.7%) with previous or current smoking and/or alcohol use; 42.8%(7 218/16 855) of patients had a disease course of 1-5 years. There were 15 630 patients(92.3%) with DLQI≥10, 8 346 patients(49.7%) with PASI≥10, 15 017 patients(89.2%) with BSA≥10%. The plaque type was the most common disease type ( n=14 965, 88.7%), and spotting type ranked the second ( n=1 141, 6.8%). The most common initial site was the trunk ( n=12 309, 72.9%). Among the comorbidities, hypertension was the most common one ( n=1 681, 10.0%). There were 7 650 reports of treatment response to conventional topical drug therapy and 3 112 reports of treatment response to systemic drug therapy, with 6 269 (81.9%) and 2 493 (80.1%) reporting poor or no response, respectively. Conclusions:The survey shows that in the county areas of China, the majority of psoriasis patients are severe patients with short course of disease, plaque type is the most common type, and hypertension is the most common comorbidity; and the conventional treatment is less effective for most patients.

【Objective:】 To understand the real psychological feelings of cancer patients after withdrawing from drug clinical trials, and provide reference for clinical healthcare professionals to serve personalized care for patients in the transitional period after withdrawing from drug clinical trials. 【Methods:】 With the descriptive phenomenology method, 11 subjects who withdrew from drug clinical trials in the oncology department of a tertiary hospital in Shandong Province were selected by intentional sampling method to conduct semi-structured in-depth interviews. Colaizzi seven-step analysis method was used to analyze and sort out records, and refine themes. 【Results:】 The psychological experiences of cancer patients after withdrawing from drug clinical trials were summarized into four themes: benefits of participating in clinical trials, losses of withdrawing from clinical trials, attitudes towards future treatment, and expectations of receiving help. 【Conclusion:】 Cancer patients face great psychological pressure after withdrawing from drug clinical trials and require deep emotional support and humanistic care. Nursing staff should take personalized care measures to meet the special problems of patients’ psychological needs, so as to help patients smoothly pass through the withdrawal stage and enter subsequent treatment.