Objective:To implement evidence-based practice for eye management in ICU patients undergoing prone position ventilation and evaluate the effectiveness of applying the best evidence for eye management in this setting.Methods:Through literature retrieval, screening, and evaluation, the best evidence for eye management in ICU patients undergoing prone position ventilation was summarized and compiled into evidence review indicators. From March to June 2024, convenience sampling was used to select 29 ICU prone position ventilation patients and 30 ICU nurses at Shanghai Changzheng Hospital for baseline review to identify obstacles in clinical practice of evidence and develop action strategies based on these obstacles. From July to October 2024, 29 ICU prone position ventilation patients and 29 ICU nurses were selected for evidence-based practice to compare the implementation rates of review indicators before and after evidence-based practice, ICU nurses' knowledge, attitude and practice regarding eye management for prone position ventilation patients, as well as the intraocular pressure during prone position ventilation and the incidence of eye complications within the first week of ICU admission.Results:After evidence-based practice, the implementation rates of all 16 review indicators by ICU nurses were higher than those before evidence-based practice, and the differences were statistically significant ( P<0.05). The total score, knowledge dimension score, and practice dimension score on the Knowledge, Attitude and Practice Questionnaire on Eye Management during Prone Position Ventilation for ICU nurses were higher than those before evidence-based practice, with statistically significant differences ( P<0.05). After evidence-based practice, the intraocular pressure of ICU patients in prone position ventilation for 8 hours and at the end improved, and the differences were statistically significant ( P<0.05). The overall incidence of eye complications within one week of ICU admission decreased from 27.6% to 6.9%, with a statistically significant difference ( P<0.05) . Conclusions:Implementing evidence-based practices for eye management in ICU patients undergoing prone position ventilation can effectively increase nurses' implementation rates of review indicators, enhance their knowledge, attitude, and practice regarding eye management, and reduce the incidence of eye complications in patients.

Objective To investigate the risk factors of acute pancreatitis(AP)complicated with hypotension and establish a prediction model.Methods From April 2020 to April 2024,198 patients with AP in our hospital were selected as the research objects.The incidence of hypotension during treatment was measured.Patients with hypotension were included in the observation group,and those without hypotension were included in the control group.The risk factors of hypotension in AP patients were screened by Logistic regression analysis.R3.5.1 software was used to establish and verify the prediction model of AP complicated hypotension based on the selected risk factors.Results Among 198 AP patients during hospitalization,88(44.44%)had hypotension.Advanced age,history of hypotension,combined hypertension,severity of disease,secondary infection and respiratory system damage were the independent risk factors for AP complicated hypotension,and higher body mass index(BMI)was the protective factor(P＜0.05).The C-index of the nomogram prediction model was 0.899,and the AUC for predicting AP with hypotension was 0.899(95%CI:0.848-0.937).The sensitivity was 85.23%,the specificity was 83.64%,the Yoden index was 0.689,the Brier score of the calibration curve was 0.146 and the calibration slope was 0.735.The risk of AP complicated with hypotension predicted by the nomogram model was in good agreement with the actual risk.Conclusion The nomogram prediction model established based on influencing factors demonstrates good discrimination and applicability in predicting AP complicated with hypotension.

Objective:To implement evidence-based practice for eye management in ICU patients undergoing prone position ventilation and evaluate the effectiveness of applying the best evidence for eye management in this setting.Methods:Through literature retrieval, screening, and evaluation, the best evidence for eye management in ICU patients undergoing prone position ventilation was summarized and compiled into evidence review indicators. From March to June 2024, convenience sampling was used to select 29 ICU prone position ventilation patients and 30 ICU nurses at Shanghai Changzheng Hospital for baseline review to identify obstacles in clinical practice of evidence and develop action strategies based on these obstacles. From July to October 2024, 29 ICU prone position ventilation patients and 29 ICU nurses were selected for evidence-based practice to compare the implementation rates of review indicators before and after evidence-based practice, ICU nurses' knowledge, attitude and practice regarding eye management for prone position ventilation patients, as well as the intraocular pressure during prone position ventilation and the incidence of eye complications within the first week of ICU admission.Results:After evidence-based practice, the implementation rates of all 16 review indicators by ICU nurses were higher than those before evidence-based practice, and the differences were statistically significant ( P<0.05). The total score, knowledge dimension score, and practice dimension score on the Knowledge, Attitude and Practice Questionnaire on Eye Management during Prone Position Ventilation for ICU nurses were higher than those before evidence-based practice, with statistically significant differences ( P<0.05). After evidence-based practice, the intraocular pressure of ICU patients in prone position ventilation for 8 hours and at the end improved, and the differences were statistically significant ( P<0.05). The overall incidence of eye complications within one week of ICU admission decreased from 27.6% to 6.9%, with a statistically significant difference ( P<0.05) . Conclusions:Implementing evidence-based practices for eye management in ICU patients undergoing prone position ventilation can effectively increase nurses' implementation rates of review indicators, enhance their knowledge, attitude, and practice regarding eye management, and reduce the incidence of eye complications in patients.

Objective To investigate the influencing factors of secondary coagulation dysfunction in patients with severe acute pancreatitis(SAP)and establish the prediction model.Methods A total of 298 SAP patients in our hospital from July 2021 to July 2024 were consecutively selected,and those with secondary coagulation dysfunction were included in the observation group,while those without secondary coagulation dysfunction were included in the control group.Multivariate Logistic regression analysis was employed to investigate the risk factors for secondary coagulation dysfunction in patients with SAP and to establish a multivariate joint prediction model.The receiver operating characteristic curve(ROC)and decision curve were used to evaluate the predictive value of the multivariate joint prediction model for secondary coagulation dysfunction in SAP patients.Results The incidence of secondary coagulation dysfunction in SAP patients was 32.21%.The activated partial thromboplastin time(APTT),prothrombin time(PT)and fibrinogen(FIB)were longer in the observation group than those in the control group(P<0.05).Acute physiological and chronic health score Ⅱ(APACHEⅡ)score,sequential organ failure assessment(SOFA)score,D-dimer,C-reactive protein and albumin were independent influencing factors of secondary coagulation dysfunction in SAP patients(P<0.05).The regression equation model was established according to the results of multivariate analysis screened variables,logit(P)=-24.747+0.363×APACHEⅡ score+0.952×SOFA score-0.449×albumin+1.768×D-dimer+1.004×C-reactive protein,with a good fit.Regression model predicted that the AUC value of secondary coagulation dysfunction in SAP patients was 0.937.Decision curve analysis results showed that the Logistic regression model could achieve the maximum clinical benefit when the threshold probability was in the range of 0.06 to 0.97.Conclusion A comprehensive assessment of influencing factors can comprehensively evaluate the condition of patients and identify patients at high risk of coagulation disorders at an early stage.

Objective To investigate the risk factors of acute pancreatitis(AP)complicated with hypotension and establish a prediction model.Methods From April 2020 to April 2024,198 patients with AP in our hospital were selected as the research objects.The incidence of hypotension during treatment was measured.Patients with hypotension were included in the observation group,and those without hypotension were included in the control group.The risk factors of hypotension in AP patients were screened by Logistic regression analysis.R3.5.1 software was used to establish and verify the prediction model of AP complicated hypotension based on the selected risk factors.Results Among 198 AP patients during hospitalization,88(44.44%)had hypotension.Advanced age,history of hypotension,combined hypertension,severity of disease,secondary infection and respiratory system damage were the independent risk factors for AP complicated hypotension,and higher body mass index(BMI)was the protective factor(P＜0.05).The C-index of the nomogram prediction model was 0.899,and the AUC for predicting AP with hypotension was 0.899(95%CI:0.848-0.937).The sensitivity was 85.23%,the specificity was 83.64%,the Yoden index was 0.689,the Brier score of the calibration curve was 0.146 and the calibration slope was 0.735.The risk of AP complicated with hypotension predicted by the nomogram model was in good agreement with the actual risk.Conclusion The nomogram prediction model established based on influencing factors demonstrates good discrimination and applicability in predicting AP complicated with hypotension.

Objective To investigate the influencing factors of secondary coagulation dysfunction in patients with severe acute pancreatitis(SAP)and establish the prediction model.Methods A total of 298 SAP patients in our hospital from July 2021 to July 2024 were consecutively selected,and those with secondary coagulation dysfunction were included in the observation group,while those without secondary coagulation dysfunction were included in the control group.Multivariate Logistic regression analysis was employed to investigate the risk factors for secondary coagulation dysfunction in patients with SAP and to establish a multivariate joint prediction model.The receiver operating characteristic curve(ROC)and decision curve were used to evaluate the predictive value of the multivariate joint prediction model for secondary coagulation dysfunction in SAP patients.Results The incidence of secondary coagulation dysfunction in SAP patients was 32.21%.The activated partial thromboplastin time(APTT),prothrombin time(PT)and fibrinogen(FIB)were longer in the observation group than those in the control group(P<0.05).Acute physiological and chronic health score Ⅱ(APACHEⅡ)score,sequential organ failure assessment(SOFA)score,D-dimer,C-reactive protein and albumin were independent influencing factors of secondary coagulation dysfunction in SAP patients(P<0.05).The regression equation model was established according to the results of multivariate analysis screened variables,logit(P)=-24.747+0.363×APACHEⅡ score+0.952×SOFA score-0.449×albumin+1.768×D-dimer+1.004×C-reactive protein,with a good fit.Regression model predicted that the AUC value of secondary coagulation dysfunction in SAP patients was 0.937.Decision curve analysis results showed that the Logistic regression model could achieve the maximum clinical benefit when the threshold probability was in the range of 0.06 to 0.97.Conclusion A comprehensive assessment of influencing factors can comprehensively evaluate the condition of patients and identify patients at high risk of coagulation disorders at an early stage.

Objective:To analyze and evaluate the application effect of magnetic navigation-guided nasojejunal tube placement in critically ill patients by literature retrieval.Methods:The Chinese databases of CNKI,Wanfang,VIP and Chinese Biomedical Literature Service System were searched,as well as the literature on randomized controlled trials of magneto-guided nasojejunal tube placement in critically ill patients in foreign language databases of PubMed,CINAHL,Cochrane Library,Web of Science,and Embase,the search period was from January 2000 to September 2023.The literature were screened according to the inclusion and exclusion criteria,and the quality of the literature was evaluated.RevMan 5.4.1 software was used to conduct a meta-analysis of the four outcomes in the literature:success rate of placement,time required for successful placement,time to recovery of vital signs,and patient satisfaction.Results:A total of 7 randomized controlled trials of 7 studies were included,including 4 Chinese studies and 3 English studies,involving 682 patients.The success rate of magnetic navigation-guided nasojejunal tube placement was higher than that of bedside blind nasojejunal tube placement,the difference was statistically significant[OR=4.78,95%CI(2.16～10.58),P<0.0001].The time required for magnetic navigation guided nasojejunal tube placement was less than that of the bedside blind nasojejunal tube placemen,the difference was statistically significant[MD=-12.91,95%CI(-22.93～-2.90,P<0.00001].The time required for recovery of vital signs in patients with magnetic navigation guided nasojejunal tube placement was less than that of the bedside blind nasojejunal tube placemen,the difference was statistically significant[MD=-9.11,95%CI(-12.09～-6.13,P<0.00001].The satisfaction of patients with the magnetic navigation-guided nasojejunal tube placement was higher than that of patients with the bedside blind nasojejunal tube placement,the difference was statistically significant[OR=11.61,95%CI(3.96～34.01),P<0.00001].Conclusion:Compared with bedside blind nasojejunal tube placement,magnetic navigation-guided nasojejunal tube placement can significantly improve the success rate of nasojejunal tube placement in critically ill patients,reduce the time required for successful nasojejunal tube placement,reduce the recovery time of patients'vital signs,and improve patient satisfaction.

Objective:To explore the clinical phenotypes, pregnancy outcomes, and follow-up of fetuses with 1q21.1 distal microdeletion/microduplication, and to provide a basis for prenatal and genetic counseling.Methods:This was a retrospective study involving 14 singleton fetuses with 1q21.1 distal microdeletion/microduplication that were prenatally diagnosed by karyotype analysis and chromosomal microarray analysis (CMA) at Wuxi Maternity and Child Health Care Hospital from January 2017 to June 2022. The results of ultrasound and genetic analysis, pregnancy outcome after genetic counseling, and postnatal follow-up were summarized using descriptive statistical methods.Results:All 14 fetuses had normal karyotypes. Out of the 14 cases, CMA indicated 1q21.1 distal microdeletion in eight cases and 1q21.1 distal microduplication in six cases. The fragments ranged from 813 kb to 4.48 Mb, all of which contained the key region of 1q21.1 microdeletion/microduplication syndrome and were pathogenic copy number variations (CNV). Among eight fetuses with distal 1q21.1 microdeletion, four cases had abnormal prenatal ultrasound findings, including one case with overlapping fingers of left hand and polyhydramnios, two were small for gestational age, and one with small head circumference. Among the six cases who underwent parental origin detection, the microdeletions were de novo in four fetuses and two fetuses were inherited from the parent with normal phenotype. As for six fetuses with distal 1q21.1 microduplication, nasal bone absence or hypoplasia was shown by ultrasound in four cases and no obvious abnormality was found in the other two cases. Parental origin detection was performed in four cases, which found that one case was de novo and the other three cases were inherited from their phenotypically normal parents. After genetic counseling, five families chose to terminate the pregnancies and the remaining nine cases continued the pregnancies to delivery. The last follow-up showed that all of the nine live births grew well, whose ages ranged from seven months to half past five years old. Conclusions:CMA is of great value in prenatal diagnosis of 1q21.1 distal microdeletion/ microduplication. Ones carrying pathogenic CNV may not develop the disease. Combined with ultrasound findings and parental genetic tracing results, individualized genetic counseling and long-term follow-up are of great importance for reasonable guidance in pregnancy outcome and reproduction.

Objective:To explore the genetic causes of cerebellar hypoplasia (CH) diagnosed by prenatal ultrasound.Methods:This retrospective study involved 32 fetuses with CH diagnosed by prenatal ultrasound in Wuxi Maternal and Child Health Hospital from January 2014 to December 2022. Prenatal ultrasound findings and genetic testing results for amniotic fluid were collected and analyzed. The correlation between fetal CH and genetic abnormality was analyzed. A descriptive statistical method was used for data analysis.Results:(1) General data: The 32 mothers were (28.0±4.9) years old, ranging from 18 to 37 years old; the gestational age at amniocentesis was (24.2±4.0) weeks, ranging from 18 +3 weeks to 37 +2 weeks. Apart from one case lost to follow-up, the other 31 cases terminated the pregnancies, including 30 terminated before 28 weeks of gestation and one at 33 weeks of gestation due to unmarried status. (2) Ultrasonic features: Among the 32 cases, 30(93.8%) were complicated by intracranial or extracranial abnormalities including cardiac abnormalities (15 cases), dilated lateral ventricles (ten cases), and abnormalities in limbs (eight cases) and face (nine cases). Two CH cases (6.2%) were isolated. (3) Genetic testing: Among the 32 cases, 13 cases (40.6%) had normal results of amniotic fluid karyotype analysis and single nucleotide polymorphism (SNP) array. Among the 19 cases with abnormal amniotic fluid test results (59.4%), 16 cases have abnormal results in amniotic fluid karyotype analysis and SNP array detection [nine cases were numerical abnormalities, including five cases of trisomy-18, three of trisomy-21, and one of trisomy-13; seven cases were chromosomal structural abnormalities, including four cases of terminal deletion of chromosome 5 (Cri-du-Chat syndrome) and three cases of reciprocal translocation of chromosomes]. There was no abnormality in karyotype analysis of amniotic fluid in three cases. Still, their SNP array test results showed copy number variations (CNV) [one of 6q terminal deletion, one of 6q terminal deletion with 5p15.33 duplication, and one of 6q terminal deletion with 15q26.3 duplication; all variations were of unknown significance]. (4) Of the 19 cases with abnormal SNP array results, 17 were accompanied by abnormal intracranial/extracranial ultrasound findings. Among them, ten cases showed cardiac malformation, seven showed lateral ventricular widening, and seven showed limb abnormality. Conclusions:Numerical abnormalities, CDCS, and 6q terminal deletion are the most common genetic causes of CH diagnosed by prenatal ultrasound. Chromosome microarray analysis should be recommended for fetuses with ultrasound-diagnosed CH to evaluate fetal prognosis accurately.

In 2016, a national one million general population cohort project was set up in China for the first time in "Precision Medicine Research" Key Project, National Key Research and Development Program of China, which consists of general population cohorts in seven areas in China. As one of the seven major areas in China, northeastern China has unique climate and specific dietary patterns, and population aging is serious in this area. And the burden of chronic and non-communicable diseases ranks tops in China. Therefore, it is of great significance to establish a large general population cohort in northeastern China to explore the area specific exposure factors related to pathogenesis and prognosis of chronic and non-communicable diseases, develop new prevention strategies to reduce the burden of the diseases and improve the population health in northeastern China. In July 2018, the general population cohort study in northeastern China was launched, the study includes questionnaire survey, health examination and blood, urine and stool sample collection and detection in recruited participants. By now, the cohort has covered all age groups, and the baseline data of 115 414 persons have been collected. This paper summarizes the design and practice of the general population cohort study in northeastern China to provide reference for related research in China.