Objective:To explore the correlation between sequential organ failure score (SOFA), serum high-sensitivity C-reactive protein (hs-CRP), D-dimer and prognosis of sepsis-induced acute respiratory distress syndrome (ARDS) patients and their joint prediction effect.Methods:Clinical data of 76 patients with sepsis complicated with ARDS diagnosed and treated in Department of Intensive Care Unit, Huangshi Central Hospital from May 2019 to May 2022 were retrospectively analyzed, and were divided into death group ( n=24) and survival group ( n=52) according to the prognosis 28 days after admission. The SOFA score, hs-CRP and D-dimer levels were compared. Independent sample t-test was used for inter group comparison of metric data that conforms to normal distribution, while χ 2 test was used for inter group comparison of count data. Binary Logistic regression model was used to analyze the risk factors affecting the prognosis of patients with ARDS caused by sepsis. The ROC curve model was used to analyze the AUC value, sensitivity and specificity of SOFA score, hs-CRP and D-D in predicting death during hospitalization in patients with sepsis complicated with ARDS. Results:In the death group, SOFA score was (6.63±1.91), hs-CRP score was (108.82±30.71) mg/L, D-dimer score was (5.17±1.53) mg/L. The survival group was (4.04±1.33), (71.11±18.18) mg/L, and (3.08±0.60) mg/L, respectively, and there were significant differences between the two groups ( t=6.84, 6.70, 8.57, all P<0.001). Binary Logistic regression analysis showed that SOFA score ( OR=2.671, 95 CI 1.726-4.135, P<0.001), hs-CRP ( OR=1.080, 95 CI 1.038-1.123, P<0.001), D-D ( OR=5.491, 95 CI 2.499-12.069, P<0.001) was an independent risk factor for the prognosis of ARDS patients with sepsis. ROC curve analysis showed that the AUC values of SOFA score, hs-CRP, D-dimer and their combination in predicting the prognosis of ARDS patients with sepsis were (0.847, 0.833, 0.867, 0.978, all P<0.001). The sensitivity was 75.00%, 62.50%, 75.00%, 87.50%; the specificity was 88.50%, 98.10%, 98.10%, 96.20%, respectively. The comparison of SOFA score with the AUC of the three-item combination, Z=2.346, P=0.018; the comparison of the AUC of the D-D and the three-item combination, Z=2.346, P=0.044; the comparison of the AUC of hs-CRP and the three-item combination, Z=2.146, P=0.03. Conclusion:SOFA score and serum hs-CRP and D-dimer levels will increase with ARDS in patients with sepsis, and dynamic monitoring of their changes can provide an important reference for prognosis evaluation.

Cerebral small vessel disease（CSVD）is one of the most major causes of cognitive dysfunction. With the acceleration of population aging in China and the development of medical imaging technology，the incidence rate of CSVD has been on the rise，and related cognitive dysfunction has become an increasingly concerning issue. Due to its insidious onset，slow progression，and lack of early warning signs，CSVD is typically found when moderate or severe cognitive impairment or even dementia already occurs，often causing irreversible damage and heavy medical burden to patients. This article reviews the impact of different imaging types of CSVD and total MRI load on cognitive function to further understand the relationship between CSVD and cognitive function，aiming to provide a reference for the identification and prevention of cognitive dysfunction caused by CSVD.

Objective:To investigate the chronic disease self efficacy, mental resilience and spiritual well-being level in patients undergoing chemotherapy after radical mastectomy for breast cancer, and to explore whether there is a mediating effect among them.Methods:This study was a cross-sectional study. A total of 376 patients undergoing chemotherapy after radical mastectomy for breast cancer were selected as the survey objects by convenience sampling method from July 2020 to April 2021 in Shandong Provincial Hospital Affiliated to Shandong First Medical University. The chronic disease self efficacy, mental resilience and spiritual well-being were evaluated by Self-Efficacy Scale for Managing Chronic Disease, Functional Assessment of Chronic Illness Therapy Spiritual Well-being, Connor-Davidson Resilience Scale. The correlation among the chronic disease self efficacy, mental resilience and spiritual well-being was tested by Pearson correlation analysis. Structural equation model was used to analyze the intermediary mechanism of the chronic disease self efficacy, mental resilience and spiritual well-being.Results:The total score for chronic disease self-efficacy of the research objects was (33.34 ± 12.77) points, the total score for mental resilience was (66.13 ± 21.67) points, and the total score for spiritual well-being was (28.41 ± 10.13) points. The chronic disease self-efficacy, mental resilience, and spiritual well-being were all positively correlated ( r values were 0.689-0.949, all P<0.01). The chronic disease self-efficacy played a partially mediating role in spiritual well-being and mental resilience in patients undergoing chemotherapy after radical mastectomy for breast cancer ( β=0.387, P<0.01), the mediating effect accounted for 43.33% of the total effect. Conclusions:The chronic disease self-efficacy can indirectly affect the level of spiritual well-being in patients undergoing chemotherapy after radical mastectomy for breast cancer. Clinical medical staff should pay attention to their psychological counseling, broaden their minds, enhance spiritual well-being, and help them recover from adversity.

Objective:To explore the mediating effect of chronic disease self-efficacy between fatigue and social support in breast cancer patients undergoing chemotherapy.Methods:This study was a cross-sectional study. From July 2020 to April 2021, convenience sampling was used to select 376 patients with breast cancer undergoing chemotherapy in the Shandong Provincial Hospital Affiliated to Shandong First Medical University as the research object. The General Information Questionnaire, Fatigue Scale-14, Chronic Disease Self-Efficacy Scale and Social Support Rating Scale were used to investigate the patients. Structural equation modeling was used to test the mediating effect among variables. A total of 376 questionnaires were distributed, and 372 valid questionnaires were recovered, with a valid recovery rate of 98.94%.Results:Among 372 breast cancer patients undergoing chemotherapy, the total scores of the Fatigue Scale-14, Chronic Disease Self-Efficacy Scale and Social Support Rating Scale were (10.61±1.81) , (5.00±2.53) and (43.42±12.59) , respectively. Chronic disease self-efficacy was positively correlated with social support in breast cancer patients undergoing chemotherapy ( r=0.493-0.648, P<0.01) , and social support was negatively correlated with fatigue ( r=-0.703--0.234, P<0.01) , and self-efficacy was negatively correlated with fatigue ( r=-0.729--0.220, P<0.01) . Chronic disease self-efficacy played a partial mediating role between fatigue and social support in breast cancer patients undergoing chemotherapy (β=-0.335, P<0.01) , and the mediating effect accounted for 47.59% of the total effect. Conclusions:Social support can indirectly affect fatigue through chronic disease self-efficacy in breast cancer patients undergoing chemotherapy. Nurses should focus on improving the chronic disease self-efficacy and social support of breast cancer patients undergoing chemotherapy.

Objective:To analyze risk factors of pleural effusion in elderly patients after radical gastrectomy and formulate lung protection interventions on this basis to explore the effect of reducing the occurrence of pleural effusion after radical gastrectomy in elderly patients.Methods:By reviewing medical records, clinical data of 208 elderly patients with gastric cancer undergoing radical gastrectomy in Shandong Provincial Hospital Affiliated to Shandong First Medical University before January 2019 were retrospectively analyzed. Univariate analysis and Logistic regression analysis were used to explore risk factors of pleural effusion in elderly patients after radical gastric cancer surgery, and based on this, lung protection interventions were formulated. A total of 200 elderly patients with gastric cancer who underwent radical gastrectomy from January 2019 to June 2020 were selected as the observation group and they were given lung protection intervention. A total of 208 elderly patients undergoing radical gastrectomy before January 2019 were used as the control group. The occurrence of postoperative pleural effusion was observed and compared between the two groups.Results:Logistic regression analysis showed that preoperative albumin level less than 30 g/L, combination with COPD, operation time more than 4 h, lung function Ⅱ-Ⅳ grade and open surgery were the risk factors for pleural effusion after radical gastrectomy in elderly patients with gastric cancer ( P<0.05) . The incidence of pleural effusion in the observation group was lower than that in the control group, and the difference was statistically significant ( χ2=7.353, P=0.005) . The degree of pleural effusion in the observation group was lighter than that in the control group, and the difference was statistically significant ( χ2=7.052, P=0.029) . Conclusions:Preoperative albumin level less than 30 g/L, combination with COPD, operation time more than 4 h, lung function Ⅱ-Ⅳ grade and open surgery are the risk factors for pleural effusion after radical gastrectomy in elderly patients with gastric cancer. According to the above risk factors, pulmonary protective interventions can effectively reduce the incidence and degree of postoperative pleural effusion in elderly patients after gastric cancer surgery.

Objective:To explore the perioperative nursing model of endoscopic thyroidectomy through the oral vestibule and its effects.Methods:Totally 127 patients who planned to undergo thyroidectomy from January 2018 to June 2019 were selected. A total of 65 patients receiving traditional surgery between January and June 2018 were included into the control group, while 62 patients who underwent endoscopic thyroidectomy through the oral vestibule from October 2018 to June 2019 were included into the experimental group. Patients in the control group received routine care, while the perioperative nursing model of endoscopic thyroidectomy through the oral vestibule was explored in the experimental group. The differences in pain scores 72 hours after surgery, days of drainage tube indwelling, length of hospital stay and complications were compared between the two groups.Results:There was statistically significant difference in the incidence of postoperative complications between the two groups ( P<0.05) ; the differences in pain scores 72 hours after surgery, days of drainage tube indwelling and length of hospital stay between the two groups were statistically significant ( P< 0.01) . Conclusions:The perioperative nursing practice of endoscopic thyroidectomy through the oral vestibule can effectively reduce the postoperative pain, number of days of drainage tube indwelling, length of hospital stay and postoperative complications in the patients.

Objective Application of PDCA method to improve the coincidence rate of emergency inspection report time.Methods 472 cases of emergency inspection report returns the fraction defective of the time from September to December 2014 (blood routine,blood biochemistry,blood coagulation,cerebrospinal fluid,urine analysis).Analyzing the reason and take measures to improve the emergency inspection report time coincidence rate.At the same time,counted 654 cases of emergency inspection report returns the fraction defective of the time after the improvement from July to November 2015,and compared and analyzed the coincidence rate before and after the improvement measures.Results Emergency inspection report of the total fraction defective return time decreased from 13.9 ％ to 4.9 ％ by taking measures.Blood coagulation,blood biochemistry,urine analysis,routine blood,cerebrospinal fluid and urine analysis of emergency return time unqualified rate decreased from 18.2 ％,16.2 ％,10.3 ％,6.75 ％ and 9.1％ to 5.2 ％,5.0 ％,6.4％,5.0 ％ and 3.9 ％ respectively.Conclusion The application of PDCA could improve the time coincidence rate of emergency department,and to finish the emergency detection and report detection results in the shortest possible time.

Objective To improve the operation method of external application of Kujiu ointment, which can enhance satisfaction and comfort level of patients, as well as improving the nursing quality. Methods Totally 112 cases of injured tendons in the ankle were chosen and divided into two groups randomly by retrospective study. Each group included 56 cases. Patients in the control group ( July 2013-June 2014) were treated by conventional methods of operation, and the ointment was fixed to the wound surface with gauze and bandage. Patients in the treatment group ( July 2014-June 2015 ) were treated with the improved medical plaster application which was fixed to the wound surface. Satisfaction degree of traditional Chinese medicine ( TCM ) nursing, comfort degree , retention time, condition of leakage ointment were compared between two groups. Results After the improvement of TCM operation methods, the patient satisfaction, comfort degree of patients in the treatment group were significantly higher than the control group ( P<0.01) . The leakage rate of ointment in the treatment group was significantly lower than the control group ( P<0. 01 ) . Conclusions The improved external application of Kujiu ointment can increase patient satisfaction and comfort level, and make more patients accept this treatment, and it also can improve the quality of nursing. It is worthy of further promotion in the clinical practice.

Objective To investigate the change and clinical value of serum cystain C(CysC)level in the patients with HBeAg-negative chronic hepatitis B(CHB).Methods 212 cases of CHB in our hospital were selected and divided into the HBeAg-negative group and the HBeAg-positive group according to the HBeAg status.105 healthy individuals at the same time were enrolled as the control group.The levels of serum CysC,ALT,AST,Cr,BUN and HBV DNA in 3 groups were detected and compared.The corre-lations between serum CysC with AST,AST,Cr,Bun,HBV DNA were analyzed by the Pearson correlation analysis.Results The mean CysC level in the HBeAg-negative group was (1 .40±0.36)mg/L,which was higher than (0.93±0.12)mg/L in the control group and (0.96±0.18)mg/L in the HBeAg-positive group,the differences between them was statistically significant(P <0.05). The CysC was significantly positively correlated with serum Cr level in the HBeAg-negative group(r=0.840,P <0.01).Conclusion The CysC level might be used as an effective index for monitoring the early kidney injury in the patients with HBeAg-negative CHB,which has important significance in the prevention and treatment of HBeAg-negative CHB.

Objective To investigate CT features on increased cerebral vascular density and its pathological mechanism in patients with cyanotic congenital heart disease(CCHD).MethodsPreoperative brain CT scan and clinical data in 82 patients suffering from CCHD were analyzed. According to the increased levels of vascular density,patients were divided into 4 groups:normal,mild,moderate and severe.Relationships between the increased levels of vascular density and Hb,RBC,HCT,as well as the degree of cyanosis,were studied.AVONA was carried out to test blood CT value of cerebral sinuses,Hb,RBC and HCT in different groups. Descriptive analysis and linear regression were adopted to study the correlation between blood CT value and Hb concentration.The relationship of increased vascular density todegrees of cyanosis was analysed by Spearman.Results Among 82 patients,12 patients ( 14.6％ ) werefound in the group of normal vascular density and 70 patients ( 85.4％ ) in the increased vascular density group.Among 70 patients with increased vascular density,22 patients (26.8％ ) with (55.4 ± 2.6) HU,(169 ±6)g/L of Hb,(5.8 ±0.3) × 1012/L of RBC and 0.51 ±0.03 of HCT,29 patients (35.4％) with (61.3 ± 2.9) HU,(209 ± 15 ) g/L,(7.1 ± 0.4) × 1012/L,0.66 ± 0.06 and 19 patients ( 23.2％ ) with ( 68.8 ± 4.2) HU,( 242 ± 23 ) g/L,( 8.3 ± 0.9 ) × 1012/L,0.78 ± 0.08 were observed in the mild,moderateand severe group,respectively.There were significant differences in distribution of blood CT value ( HU),Hb,RBC and HCT in different groups ( F =163.263,134.703,120.974,136.541 ;P ＜ 0.01 ).Blood CT value was positively correlated with Hb concentration ( r =0.98,P ＜ 0.01 ). Vascular density was also positively correlated with the degree of cyanosis ( r =0.86,P ＜ 0.01 ). Conclusions Cerebral vascular density of patients suffering from CCHD presented different levels of increases based on CT scan results due to rise of RBC stimulated by anoxia.The increased level of vascular density was positively correlated with blood Hb concentration,and also associated with RBC accunulation caused by abnormal blood circulation.Moreover,it was positively correlated with the degree of cyanosis.