Existentialist philosophy focuses on human existence， explores subjectivity and uniqueness， and highlights the value of human existence. Advanced cancer patients generally suffer immense existential distress， each with their own modes of appearance and numerous possibilities. From the perspective of existentialist philosophy， targeting the group of advanced cancer patients， this paper clarified the analysis of “Dasein” （holistic phenomenon and modes of appearance）. Through recognition （achieving to deepen the inner scope of the subject and object） and comprehension （seeking appropriate “self-knowledge”）， it introduced the planning of variable possibilities. Subsequently， based on the patients’ pre-possessing， pre-seeing， and pre-grasping， explanatory activities were carried out to complete the “self-formation” in the planning. Ultimately， it facilitated the realization of existential meaning in the presupposition and proposed actionable clinical practices （meaning therapy and emotional touch therapy） to alleviate the existential distress of advanced cancer patients.

Objective:To summarize the long-term efficacy of nicotinamide in treating pediatric early-onset progressive encephalopathy with brain edema and (or) leukoencephalopathy-2 (PEBEL2) caused by NAXD gene variation .Methods:This was a case report conducted from February 2019 to January 2025. The long-term efficacy of nicotinamide was observed by following up a child with PEBEL2 who received the treatment in the Department of Neurology, Beijing Children′s Hospital Affiliated to Capital Medical University. The clinical data included changes in skin lesions, neurological symptoms. The modified Rankin scale (mRS) was used to evaluate the recovery of neurological function.Results:A boy was diagnosed with PEBEL2 caused by NAXD gene variation via genetic testing at Beijing Children′s Hospital Affiliated to Capital Medical University in February 2019, when he was 4 years and 6 months of age. Immediately after diagnosis, nicotinamide treatment was initiated at an initial dose of 100 mg/d, which was increased by 100 mg per week and gradually increased to 500 mg/d; meanwhile, other therapeutic drugs were gradually discontinued. After 1 year and 8 months of treatment, the child′s skin lesions had completely resolved; at the 2-year follow-up, dystonia in both upper limbs and swallowing dysfunction was alleviated significantly; by 2.5-year follow-up, his cognitive function also showed improvement. When the child was treated with 500 mg/d for 3 years, a rash appeared around the mouth. After the dose was reduced to 250 mg/d, the rash resolved, and the dose of 250 mg/d was maintained until the last follow-up. At the last follow-up in January 2025, the child was 10 years and 5 months of age. His mRS score decreased from 5 (before treatment) to 4. During the 6-year of continuous nicotinamide treatment, the child′s condition remained stable without progression. Drug-related skin rashes occurred, but no severe drug-related adverse reactions were observed.Conclusions:PEBEL2 is a treatable mitochondrial disease. Nicotinamide treatment can effectively improve skin lesions and neurological symptoms in PEBEL2 patients, and the long-term administration demonstrates a favorable safety profile.

Objective:To conduct a scoping review of the current state of research on social alienation in stroke survivors, its influencing factors, and assessment tools, and to provide a theoretical basis as well as a reference for clinical prevention of social alienation in stroke survivors.Methods:A systematic search was conducted for relevant literatures on the factors affecting social alienation of stroke survivors in domestic and foreign databases such as PubMed, Cochrane Library, Wanfang Database, etc, and the search period was established until April 29, 2024. After a rigorous assessment of quality, the pertinent literature was condensed and scrutinized.Results:A total of 11 literatures were included, with 9 Chinese literatures and 2 English literatures, the research instrument was based on the General Detachment Scale, involved 22 influencing factors of social alienation among stroke survivors.Conclusions:Stroke survivors lack specific assessment tools for social alienation. In the future, localized and specific assessment tools should be developed, and targeted intervention measures should be formulated based on the influencing factors related to the social alienation of stroke survivors to improve their social alienation.

Objective:To explore the effect of Swanson theory combined with hand touch on the existential distress of patients with advanced lung cancer, in order to provide reference for clinical humanistic care.Methods:A non synchronous controlled study was conducted using convenience sampling to select advanced lung cancer patients admitted to the Oncology Department of the First People's Hospital of Yongkang City, Zhejiang Province from October 2023 to March 2024 as the control group, and advanced lung cancer patients admitted from April to October 2024 as the experimental group. The control group received routine care, while the experimental group received Swanson theory combined with hand touch intervention on the basis of routine care. The Existential Distress Scale (EDS) and Functional Assessment of Cancer Therapy- General (FACT-G) scores of the two groups were compared before and 2 weeks after intervention.Results:During the study period, there were 3 dropouts in the experimental group and 2 dropouts in the control group. Finally, 37 cases were included in the experimental group, including 16 males and 21 females, with an age of (62.35 ± 12.13) years. There were 38 cases in the control group, including 25 males and 13 females, with an age of (65.68 ± 13.46) years. After 2 weeks of intervention, the EDS score of the experimental group patients was (6.65 ± 2.89) points, while that of the control group was (8.16 ± 2.27) points. The difference between the two groups was statistically significant ( t = 2.52, P<0.05). After intervention, the social/family status dimension, emotional status dimension, and total score of FACT-G in the experimental group were (15.35 ± 4.18), (19.27 ± 3.54), and (57.46 ± 14.69) points, respectively, which were better than the control group's (13.08 ± 3.77), (16.53 ± 3.88), and (50.58 ± 11.86) points. The difference between the two groups was statistically significant ( t = - 2.47, - 3.20, - 2.24, all P<0.05). Conclusions:The combination of Swanson theory and hand touch can effectively reduce the existential distress of patients with advanced lung cancer, improve their quality of life, and embody the concept of nursing humanistic care into simple and safe intervention measures, providing reference for clinical humanistic care.

Objective:To summarize the long-term efficacy of nicotinamide in treating pediatric early-onset progressive encephalopathy with brain edema and (or) leukoencephalopathy-2 (PEBEL2) caused by NAXD gene variation .Methods:This was a case report conducted from February 2019 to January 2025. The long-term efficacy of nicotinamide was observed by following up a child with PEBEL2 who received the treatment in the Department of Neurology, Beijing Children′s Hospital Affiliated to Capital Medical University. The clinical data included changes in skin lesions, neurological symptoms. The modified Rankin scale (mRS) was used to evaluate the recovery of neurological function.Results:A boy was diagnosed with PEBEL2 caused by NAXD gene variation via genetic testing at Beijing Children′s Hospital Affiliated to Capital Medical University in February 2019, when he was 4 years and 6 months of age. Immediately after diagnosis, nicotinamide treatment was initiated at an initial dose of 100 mg/d, which was increased by 100 mg per week and gradually increased to 500 mg/d; meanwhile, other therapeutic drugs were gradually discontinued. After 1 year and 8 months of treatment, the child′s skin lesions had completely resolved; at the 2-year follow-up, dystonia in both upper limbs and swallowing dysfunction was alleviated significantly; by 2.5-year follow-up, his cognitive function also showed improvement. When the child was treated with 500 mg/d for 3 years, a rash appeared around the mouth. After the dose was reduced to 250 mg/d, the rash resolved, and the dose of 250 mg/d was maintained until the last follow-up. At the last follow-up in January 2025, the child was 10 years and 5 months of age. His mRS score decreased from 5 (before treatment) to 4. During the 6-year of continuous nicotinamide treatment, the child′s condition remained stable without progression. Drug-related skin rashes occurred, but no severe drug-related adverse reactions were observed.Conclusions:PEBEL2 is a treatable mitochondrial disease. Nicotinamide treatment can effectively improve skin lesions and neurological symptoms in PEBEL2 patients, and the long-term administration demonstrates a favorable safety profile.

Objective:To describe the current status of responsive caregiving behavior of infant mothers,to analyze their influencing factors and pathways using the information-motivation-behavioral skills(IMB)model,and to provide a basis for further interventions related to responsive caregiving be-haviors and comprehensive promotion of early childhood development.Methods:This study was a cross-sectional survey using convenience sampling.Questionnaires were used to collect basic information about mothers and their infants,as well as data on mothers' responsive caregiving behavior,knowledge of re-sponsive caregiving,social support,and parenting self-efficacy.Multivariate linear regression models were employed to analyze the influencing factors of responsive caregiving behavior,and structural equa-tion modeling was used to analyze the pathways of these influencing factors.The criterion for inadequate responsive caregiving is defined as scores not exceeding the lower quartile(P25)of the total score.Results:Among 510 mothers of aged 0-12 months infants in Weifang City,the average score for respon-sive caregiving behavior was 16.41±3.99.The proportion of inadequate responsive caregiving was 25.7％.Mothers in the insufficient responsive caregiving group had lower scores in knowledge(7.70±1.41),social support(57.92±15.16),and parenting self-efficacy(30.36±6.48)compared with those in the sufficient group,with statistically significant differences(P＜0.001).Logistic regres-sion analysis indicated that the influencing factors for responsive caregiving included the level of know-ledge about responsive parenting[adjusted OR(aOR)=0.795,95％CI:0.566-0.838],social support(aOR=0.979,95％CI:0.961-0.996),and parenting self-efficacy(aOR=0.894,95％CI:0.857-0.932).Structural equation modeling revealed that knowledge of responsive caregiving(β=0.089,P=0.031),social support(β=0.153,P=0.001),and parenting self-efficacy(β=0.296,P＜0.001)were directly related to responsive caregiving behavior.Additionally,knowledge of responsive caregiving indirectly affected responsive caregiving behavior through parenting self-efficacy(β=0.095,P=0.014),and social support indirectly affected responsive caregiving behavior through parenting self-efficacy(β=0.497,P＜0.001).Conclusion:The current level of responsive caregiving behavior among mothers of 0-1-year-old infants in Weifang City is not satisfactory.Future development of responsive care-giving interventions should focus on providing caregivers with relevant knowledge of responsive caregiving based on their needs.Additionally,it is essential to offer social support from multiple aspects to enhance caregivers' parenting self-efficacy,thereby promoting improvements in responsive caregiving behavior.

Objective:To conduct a scoping review of the current state of research on social alienation in stroke survivors, its influencing factors, and assessment tools, and to provide a theoretical basis as well as a reference for clinical prevention of social alienation in stroke survivors.Methods:A systematic search was conducted for relevant literatures on the factors affecting social alienation of stroke survivors in domestic and foreign databases such as PubMed, Cochrane Library, Wanfang Database, etc, and the search period was established until April 29, 2024. After a rigorous assessment of quality, the pertinent literature was condensed and scrutinized.Results:A total of 11 literatures were included, with 9 Chinese literatures and 2 English literatures, the research instrument was based on the General Detachment Scale, involved 22 influencing factors of social alienation among stroke survivors.Conclusions:Stroke survivors lack specific assessment tools for social alienation. In the future, localized and specific assessment tools should be developed, and targeted intervention measures should be formulated based on the influencing factors related to the social alienation of stroke survivors to improve their social alienation.

Objective:To explore the effect of Swanson theory combined with hand touch on the existential distress of patients with advanced lung cancer, in order to provide reference for clinical humanistic care.Methods:A non synchronous controlled study was conducted using convenience sampling to select advanced lung cancer patients admitted to the Oncology Department of the First People's Hospital of Yongkang City, Zhejiang Province from October 2023 to March 2024 as the control group, and advanced lung cancer patients admitted from April to October 2024 as the experimental group. The control group received routine care, while the experimental group received Swanson theory combined with hand touch intervention on the basis of routine care. The Existential Distress Scale (EDS) and Functional Assessment of Cancer Therapy- General (FACT-G) scores of the two groups were compared before and 2 weeks after intervention.Results:During the study period, there were 3 dropouts in the experimental group and 2 dropouts in the control group. Finally, 37 cases were included in the experimental group, including 16 males and 21 females, with an age of (62.35 ± 12.13) years. There were 38 cases in the control group, including 25 males and 13 females, with an age of (65.68 ± 13.46) years. After 2 weeks of intervention, the EDS score of the experimental group patients was (6.65 ± 2.89) points, while that of the control group was (8.16 ± 2.27) points. The difference between the two groups was statistically significant ( t = 2.52, P<0.05). After intervention, the social/family status dimension, emotional status dimension, and total score of FACT-G in the experimental group were (15.35 ± 4.18), (19.27 ± 3.54), and (57.46 ± 14.69) points, respectively, which were better than the control group's (13.08 ± 3.77), (16.53 ± 3.88), and (50.58 ± 11.86) points. The difference between the two groups was statistically significant ( t = - 2.47, - 3.20, - 2.24, all P<0.05). Conclusions:The combination of Swanson theory and hand touch can effectively reduce the existential distress of patients with advanced lung cancer, improve their quality of life, and embody the concept of nursing humanistic care into simple and safe intervention measures, providing reference for clinical humanistic care.

Objective:To explore the impact of the two-way referral model on compliance and prognosis in patients with heart failure.Methods:This bidirectional cohort study enrolled chronic heart failure (CHF) patients treated at Qilu Hospital of Shandong University or designated primary hospitals between March 2018 and March 2022. Patients were categorized into two groups based on referral status: two-way referral group (participating in the referral model with≥1 follow-up visit at primary hospitals) and the core hospital group (receiving treatment and follow-up exclusively at Qilu Hospital). Baseline clinical characteristics were collected and compared between groups. Patients underwent followed-up, with primary endpoints including follow-up rate, drug (β-blockers, angiotension converting enzyme inhibitor (ACEI)/angiotensin Ⅱ receptor blockers (ARB)/angiotensin receptor-neprilysin inhibitor (ARNI), sodium-glucose cotransporter 2 inhibitors and mineralocorticoid receptor antagonists) utilization rate and target dose achievement rate. Secondary endpoints encompassed changes from baseline in left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), and N-terminal pro-brain natriuretic peptide (NT-proBNP), plus cardiovascular mortality and heart failure rehospitalization. Generalized linear mixed models analyzed longitudinal trends in LVEF, LVEDd, and NT-proBNP levels. Kaplan-Meier curves and Cox regression evaluated LVEF recovery rates, supplemented by subgroup analyses. Multivariate logistic regression was used to identify factors influencing target dose achievement rate for β-blockers and ACEI/ARB/ARNI therapies in CHF patients.Results:A total of 357 patients were enrolled, aged 53 (41, 63) years, including 256 males (71.7%). 157 patients were in the two-way referral group and 200 patients in the core hospital-treated group. Compared with the core hospital-treated group, the two-way referral group had lower baseline LVEF (28 (22, 34)% vs. 31 (23, 36)%, P=0.021) and systolic blood pressure (116 (104, 125) mmHg vs. 121 (109, 134) mmHg (1 mmHg=0.133 kPa), P=0.010). The 12-month follow-up rate of the two-way referral group was higher than the core hospital-treated group (73.8% vs. 56.0%, P=0.004). No significant between-group differences were observed in drug utilization rate of β-blockers, ACEI/ARB/ARNI, or sodium-glucose cotransporter 2 inhibitors during follow-up (all P>0.05), while mineralocorticoid receptor antagonists use showed a declining trend in both groups. Although the core hospital-treated group had higher target dose achievement rates for β-blockers (65.4% vs. 49.3%, P=0.042) and ACEI/ARB/ARNI (79.8% vs. 65.8%, P=0.046) than the two-way referral group, multivariate logistic regression indicated that the two-way referral model was not a negative predictor for these outcomes (all P>0.05). Both groups showed improved NT-proBNP, LVEDd, and LVEF from baseline (all P<0.001) with no significant difference in trends between groups (all P>0.05). There was no significant difference in the composite incidence (7.6% vs. 6.5%, P=0.674) and cumulative incidence (log-rank P=0.684) of cardiovascular death and heart failure rehospitalization at 12 months between two groups. Conclusion:The two-way referral model demonstrates advantages in improving medication adherence, drug utilization rates, and targetdoseachievement rates among CHF patients. This model not only promotes cardiac functional recovery but also reduces risks of cardiovascular mortality and heart failure rehospitalization, achieving comparable therapeutic and management outcomes to those observed in core hospital-treated patients.

Objective:To describe the current status of responsive caregiving behavior of infant mothers,to analyze their influencing factors and pathways using the information-motivation-behavioral skills(IMB)model,and to provide a basis for further interventions related to responsive caregiving be-haviors and comprehensive promotion of early childhood development.Methods:This study was a cross-sectional survey using convenience sampling.Questionnaires were used to collect basic information about mothers and their infants,as well as data on mothers' responsive caregiving behavior,knowledge of re-sponsive caregiving,social support,and parenting self-efficacy.Multivariate linear regression models were employed to analyze the influencing factors of responsive caregiving behavior,and structural equa-tion modeling was used to analyze the pathways of these influencing factors.The criterion for inadequate responsive caregiving is defined as scores not exceeding the lower quartile(P25)of the total score.Results:Among 510 mothers of aged 0-12 months infants in Weifang City,the average score for respon-sive caregiving behavior was 16.41±3.99.The proportion of inadequate responsive caregiving was 25.7％.Mothers in the insufficient responsive caregiving group had lower scores in knowledge(7.70±1.41),social support(57.92±15.16),and parenting self-efficacy(30.36±6.48)compared with those in the sufficient group,with statistically significant differences(P＜0.001).Logistic regres-sion analysis indicated that the influencing factors for responsive caregiving included the level of know-ledge about responsive parenting[adjusted OR(aOR)=0.795,95％CI:0.566-0.838],social support(aOR=0.979,95％CI:0.961-0.996),and parenting self-efficacy(aOR=0.894,95％CI:0.857-0.932).Structural equation modeling revealed that knowledge of responsive caregiving(β=0.089,P=0.031),social support(β=0.153,P=0.001),and parenting self-efficacy(β=0.296,P＜0.001)were directly related to responsive caregiving behavior.Additionally,knowledge of responsive caregiving indirectly affected responsive caregiving behavior through parenting self-efficacy(β=0.095,P=0.014),and social support indirectly affected responsive caregiving behavior through parenting self-efficacy(β=0.497,P＜0.001).Conclusion:The current level of responsive caregiving behavior among mothers of 0-1-year-old infants in Weifang City is not satisfactory.Future development of responsive care-giving interventions should focus on providing caregivers with relevant knowledge of responsive caregiving based on their needs.Additionally,it is essential to offer social support from multiple aspects to enhance caregivers' parenting self-efficacy,thereby promoting improvements in responsive caregiving behavior.