Atrial fibrillation(AF)is one of the most common clinical arrhythmias and a significant risk factor for thromboembolism.The left atrial appendage(LAA)is the primary site of thrombus formation in AF patients.Recent studies have explored the mechanisms of LAA thrombosis from multiple dimensions,including anatomical structure(LAA morphology and architecture),functional indicators(hemodynamic alterations),pathophysiological mechanisms(endothelial injury,inflammatory activation),systemic diseases(renal dysfunction)and genetic factors(gene polymorphisms),providing critical evidence for precise clinical anticoagulation.This article systematically reviews the latest research advances in the mechanisms of LAA thrombosis in AF patients,aiming to offer theoretical support for the accurate assessment of thromboembolic risk and the formulation of individualized anticoagulation strategies.Additionally,it lays the foundation for exploring the intrinsic relationship and mechanisms between LAA hemodynamics and heart failure as well as thromboembolic events.

Objective To summarize the current status of outcome indicators in randomized controlled trials of TCM intervention in pediatric myocarditis,to explore the existing problems,and to provide a reference for the construction of a core set of indicators for the treatment of pediatric myocarditis with TCM.Methods Randomized controlled trial literature on the treatment of pediatric myocarditis with TCM was retrieved from CNKI,Wanfang Data,VIP,SinoMed,PubMed,Embase,Cochrane Library and Web of Science from the establishment of the databases to 16th,Nov.2024.The basic characteristics,diagnostic criteria,TCM evidence,interventions and outcome indicators of the studies were extracted.The risk of bias was assessed for the selected studies using the Cochrane Collaboration's risk of bias tool(RoB 2.0),and the outcome indicators were statistically analyzed using Excel 2019.Results Finally,totally of 250 articles were included in the literature.The outcome indicators were counted to obtain 187 outcome indicators with a cumulative total of 1 540 occurrences,which were categorized into six indicator domains:symptoms and signs,physicochemical testing,TCM symptoms/signs,clinical efficacy evaluation,safety evaluation and quality of life evaluation;among them,the physicochemical testing indicators(112 types,926 times)had the highest frequency of occurrences,followed by the clinical efficacy evaluation(13 types.340 times),and safety evaluation(24 types,193 times).Conclusion The overall quality of randomized controlled trials of TCM treatment of pediatric myocarditis is low,and there are problems with primary and secondary differentiation of outcome indicators and lack of TCM characteristics.There is an urgent need to improve the core set of endpoint indicators that highlight the characteristics of TCM in order to improve the quality of clinical research.

Objective:To summarize the best evidence for frailty management in patients undergoing postoperative chemotherapy for gastric cancer, so as to provide reference for alleviating patient frailty.Methods:Guidelines, expert consensus, evidence summaries, systematic reviews, and randomized controlled trials and other articles on the frailty management of patients with postoperative chemotherapy for gastric cancer were electronically searched in computerized decision-making systems such as UpToDate, BMJ Best Practice, and Guidelines International Network, in comprehensive databases such as PubMed, Embase, and Web of Science, and in the websites of professional societies. The search period was from database establishment to September 15, 2024. Two researchers independently screened the literature and evaluated the quality of the included literature, combining professional judgment to extract and summarize the best evidence.Results:A total of 18 papers were included, including two clinical decisions, one evidence summary, eight guidelines, two expert consensus, one systematic review, one randomized controlled trial, two quasi-experimental studies, and one observational study. The best evidence included a total of 34 pieces in seven aspects of comprehensive screening, nursing plan construction, preoperative prehabilitation, nutritional interventions, Chinese medicine interventions, exercise interventions, and psychological interventions for frailty.Conclusions:The summary of the best evidence for frailty management in patients undergoing postoperative chemotherapy for gastric cancer may provide an evidence-based basis for frailty interventions by clinical medical and staff.

Objective:To systematically evaluate patients' experience of receiving home parenteral nutrition (HPN) , and to provide a reference for improving patients' quality of life and developing relevant clinical nursing measures.Methods:Qualitative studies on patients' experiences, feelings and needs for HPN were electronically searched in PubMed, Cochrane Library, Web of Science, Embase, China National Knowledge Infrastructure, Wanfang Data, and VIP. The search period was from database establishment to April 1, 2024. Literature quality was evaluated using the quality evaluation criteria for qualitative research of the Joanna Briggs Institute Evidence-Based Health Care Center. The pooled Meta-synthesis was used to integrate the findings.Results:A total of 14 papers were included. Sixty-six themes were distilled and classified into nine categories, resulting in three integrated outcomes, namely, the differential emotional psychology, decreased life experience, and multidimensional unmet needs in HPN patients.Conclusions:Medical and nursing staff should pay attention to patients' psychological changes and life experience during HPN, understand patients' needs and implement interventions in a holistic and individualized manner, and strengthen monitoring and guidance.

Atrial fibrillation(AF)is one of the most common clinical arrhythmias and a significant risk factor for thromboembolism.The left atrial appendage(LAA)is the primary site of thrombus formation in AF patients.Recent studies have explored the mechanisms of LAA thrombosis from multiple dimensions,including anatomical structure(LAA morphology and architecture),functional indicators(hemodynamic alterations),pathophysiological mechanisms(endothelial injury,inflammatory activation),systemic diseases(renal dysfunction)and genetic factors(gene polymorphisms),providing critical evidence for precise clinical anticoagulation.This article systematically reviews the latest research advances in the mechanisms of LAA thrombosis in AF patients,aiming to offer theoretical support for the accurate assessment of thromboembolic risk and the formulation of individualized anticoagulation strategies.Additionally,it lays the foundation for exploring the intrinsic relationship and mechanisms between LAA hemodynamics and heart failure as well as thromboembolic events.

Objective To summarize the current status of outcome indicators in randomized controlled trials of TCM intervention in pediatric myocarditis,to explore the existing problems,and to provide a reference for the construction of a core set of indicators for the treatment of pediatric myocarditis with TCM.Methods Randomized controlled trial literature on the treatment of pediatric myocarditis with TCM was retrieved from CNKI,Wanfang Data,VIP,SinoMed,PubMed,Embase,Cochrane Library and Web of Science from the establishment of the databases to 16th,Nov.2024.The basic characteristics,diagnostic criteria,TCM evidence,interventions and outcome indicators of the studies were extracted.The risk of bias was assessed for the selected studies using the Cochrane Collaboration's risk of bias tool(RoB 2.0),and the outcome indicators were statistically analyzed using Excel 2019.Results Finally,totally of 250 articles were included in the literature.The outcome indicators were counted to obtain 187 outcome indicators with a cumulative total of 1 540 occurrences,which were categorized into six indicator domains:symptoms and signs,physicochemical testing,TCM symptoms/signs,clinical efficacy evaluation,safety evaluation and quality of life evaluation;among them,the physicochemical testing indicators(112 types,926 times)had the highest frequency of occurrences,followed by the clinical efficacy evaluation(13 types.340 times),and safety evaluation(24 types,193 times).Conclusion The overall quality of randomized controlled trials of TCM treatment of pediatric myocarditis is low,and there are problems with primary and secondary differentiation of outcome indicators and lack of TCM characteristics.There is an urgent need to improve the core set of endpoint indicators that highlight the characteristics of TCM in order to improve the quality of clinical research.

Objective:To summarize the best evidence for frailty management in patients undergoing postoperative chemotherapy for gastric cancer, so as to provide reference for alleviating patient frailty.Methods:Guidelines, expert consensus, evidence summaries, systematic reviews, and randomized controlled trials and other articles on the frailty management of patients with postoperative chemotherapy for gastric cancer were electronically searched in computerized decision-making systems such as UpToDate, BMJ Best Practice, and Guidelines International Network, in comprehensive databases such as PubMed, Embase, and Web of Science, and in the websites of professional societies. The search period was from database establishment to September 15, 2024. Two researchers independently screened the literature and evaluated the quality of the included literature, combining professional judgment to extract and summarize the best evidence.Results:A total of 18 papers were included, including two clinical decisions, one evidence summary, eight guidelines, two expert consensus, one systematic review, one randomized controlled trial, two quasi-experimental studies, and one observational study. The best evidence included a total of 34 pieces in seven aspects of comprehensive screening, nursing plan construction, preoperative prehabilitation, nutritional interventions, Chinese medicine interventions, exercise interventions, and psychological interventions for frailty.Conclusions:The summary of the best evidence for frailty management in patients undergoing postoperative chemotherapy for gastric cancer may provide an evidence-based basis for frailty interventions by clinical medical and staff.

Objective:To systematically evaluate patients' experience of receiving home parenteral nutrition (HPN) , and to provide a reference for improving patients' quality of life and developing relevant clinical nursing measures.Methods:Qualitative studies on patients' experiences, feelings and needs for HPN were electronically searched in PubMed, Cochrane Library, Web of Science, Embase, China National Knowledge Infrastructure, Wanfang Data, and VIP. The search period was from database establishment to April 1, 2024. Literature quality was evaluated using the quality evaluation criteria for qualitative research of the Joanna Briggs Institute Evidence-Based Health Care Center. The pooled Meta-synthesis was used to integrate the findings.Results:A total of 14 papers were included. Sixty-six themes were distilled and classified into nine categories, resulting in three integrated outcomes, namely, the differential emotional psychology, decreased life experience, and multidimensional unmet needs in HPN patients.Conclusions:Medical and nursing staff should pay attention to patients' psychological changes and life experience during HPN, understand patients' needs and implement interventions in a holistic and individualized manner, and strengthen monitoring and guidance.

Objective To investigate the effect of vonoprazan fumarate on serum inflammatory factors in patients with reflux esophagitis.Methods Eighty patients with reflux esophagitis who were admitted to the Suzhou 100 Hospital from May 2021 to March 2023 were enrolled and divided into observation group(treated with vonoprazan fumarate,n=40)and control group(treated with omeprazole,n=40)according to the random number table method.The treatment efficacy,adverse reactions,Gastroesophageal Reflux Disease Questionnaire(GERDQ)score,gastrointestinal symptom score(GIS),serum gastrin(GAS),vasoactive intestinal peptide(VIP),tumor necrosis factor-α(TNF-α),interleukin(IL)-6,IL-8,and the recurrence within 6 months after treatment were compared between the two groups.Results The total effective rate of the observation group was higher than that of the control group(P<0.05).GERDQ score and GIS after treatment were lower than those before treatment in both groups,and the GERDQ score and GIS after treatment in the observation group were lower than those in the control group(all P<0.05).GAS after treatment was higher than that before treatment in both groups,and GAS after treatment in the observation group was significantly higher than that in the control group(all P<0.05).VIP,TNF-α,IL-6 and IL-8 after treatment were significantly lower than those before treatment in both groups,and after treatment these parameters in the observation group were significantly lower than those in the control group(all P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05).No patients were lost during follow up.The recurrence rate was 2.50%(1/40)in the observation group and 7.50%(3/40)in the control group(χ2=0.263,P=0.608).Conclusion In treating reflux esophagitis with vonoprazan fumarate,the pharyngeal reflux,gastrointestinal hormones,and serum inflammatory factor levels can be improved,and the long-term efficacy is satisfactory.

OBJECTIVE To investigate the effects of 0.2% chloroprocaine combined with ropivacaine on epidural labor analgesia and median effective concentration （EC50） of ropivacaine. METHODS Totally 67 parturients who scheduled for vaginal delivery and required epidural labor analgesia were collected from our hospital from July to October 2023 and randomly divided into RL group （33 cases） and R group （34 cases）. The concentration of ropivacaine was determined by modified Dixon sequential method. RL group was given 0.2% Chloroprocaine hydrochloride injection+Ropivacaine hydrochloride injection+0.4 μg/mL Sufentanil citrate injection； R group was given Ropivacaine hydrochloride injection+0.4 μg/mL Sufentanil citrate injection. EC50 of ropivacaine， analgesic effect during delivery， total dosage of analgesic drugs， analgesic satisfaction score， the incidence of adverse reactions， delivery status， and Apgar score of newborns were observed in two groups. RESULTS EC50 of ropivacaine， onset time， remedial analgesia rate， the incidence of perineal distension and breakthrough pain and total dosage of analgesic drugs of RL group were significantly lower than R group， and analgesic satisfaction score was significantly higher than R group （P＜0.05）. There was no statistical significance in the incidence of adverse reactions such as numbness， weakness， and chills in the lower limbs， or the duration of labor， amount of bleeding， mode of delivery， and Apgar score of newborns between 2 groups （P＞0.05）. CONCLUSIONS For epidural labor analgesia， 0.2% chloroprocaine combined with ropivacaine can reduce EC50 of ropivacaine， improve analgesia effect and have good safety.