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 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 analyze the curative effect of suspended airless laparoscopic surgery on inguinal hernia in children.Methods 180 children with inguinal hernia who received treatment at the Fourth Affiliated Hospital of Guangzhou Medical University from June 2020 to February 2023 were selected.Random number table method was used to divide the patients into two groups,90 cases in each group.The control group underwent laparoscopic high ligation of hernia sac,the observation group was treated with suspended airless laparoscopic surgery,and the clinical efficacy and surgical situation,postoperative pain and stress index levels,as well as the impact on testicular volume and quality of life,complications,and recurrence rate were compared between the two groups.Results There was no statistically significant difference in clinical efficacy between the two groups of children(P＞0.05).The surgical performance of the observation group was better than that of the control group(P＜0.05).The scores of the simplified McGill pain questionnaire were(23.23±5.11)points and(25.51±5.21)points in the observation group and control group 12 hours after surgery,and(20.02±4.55)points and(22.73±4.46)points on the first day after surgery,respectively.3 days after surgery,the scores were(11.76±1.71)points and(12.63±1.82)points,respectively,and the difference between the two groups was statistically significant(P＜0.05).On the second day after surgery,the elevated levels of stress indicators such as interleukin-6(IL-6),interleukin-10(IL-10),cortisol(Cor),and malondialdehyde(MDA)in the observation group were lower than those in the control group[(29.03±4.21)ng/L vs(30.86±4.15)ng/L,(30.12±4.23)ng/L vs(32.02±4.41)ng/L,(47.11±6.63)mmol/L vs(50.17±6.71)mmol/L,(24.31±5.18)μmol/L vs(26.63±5.25)pmol/L](all P＜0.05).There was no statistically significant difference in testicular volume between the two groups(P＞0.05),while the quality of life score of the observation group was lower than that of the control group(P＜0.05).The incidence and recurrence rates of complications such as scrotal edema and inguinal pain in the observation group were not statistically significant compared to the control group(P＞0.05),but the subcutaneous emphysema rate in the observation group was lower than that in the control group(P＜0.05).Conclusion Suspended gasless laparoscopic surgery and laparoscopic high ligation of hernia sac have good therapeutic effects in treating pediatric inguinal hernia,while the former has advantages in reducing postoperative pain and stress response.

Objective:To analyze the clinical characteristics of intracranial infection caused by Mycobacterium lentiflavum. Methods:The clinical data of a patient with intracranial infection caused by Mycobacterium lentiflavum admitted to Tianjin Haihe Hospital in May 2023 were collected. Meanwhile relevant literatures in databases were searched. Only 1 English literature (1 patient) was obtained. The clinical characteristics of this patient and the case reported in the literature were analyzed and summarized. Results:Totally 2 patients, including this case, and the patient with meningoencephalitis caused by Mycobacterium lentiflavum reported in the literature, both are females, 42 and 55 years old respectively, both manifested a chronic course, without fever, and presented progressive headache and cognitive impairment. Clinical manifestations also included abnormal mental behavior, limb weakness, and seizure. At the early stage, only intracranial pressure increased, and cerebrospinal fluid tests were negative. As the disease aggravated, there was an elevation of cerebrospinal fluid cells and protein, with normal levels of glucose and chloride. Using brain tissue obtained by biopsy for polymerase chain reaction or next-generation sequencing examination, the pathogenic microorganism was confirmed, which made accurate diagnosis possible. Antibiotic treatment had good efficacy, with a long treatment course and a good prognosis. Conclusions:Central nervous system infection caused by Mycobacterium lentiflavum is very rare, and a chronic disease course makes diagnosis very difficult. The treatment effect is significant, and the prognosis is excellent.

Depression after myocardial infarction is closely related to the theory of ascending and descending of qi and blood. The core pathogenesis is analyzed as disorder of qi and blood, mental damage, uncontrolled upward and downward movement, and pivot movement failure. The treatment method is to regulate qi and blood, invigorate qi and activate blood circulation and restore the rise and fall of visceral qi. Nourishing qi and promoting blood circulation should invigorate qi in the first. Appropriate blood activating drugs should be selected according to the degree of blood stasis, so that the blood circulation is smooth and the spirit has dependence. The key to restoring the normal balance of qi movement of visceral organs is to regulate not only liver ascending and lung descending but also spleen. Clinicians need pay attention to the nature of drug lifting and falling, conforming the physiological functions of the organs, to restore the rising and falling of the qi movement of internal organs.

ObjectiveTo understand the utilization of preconception healthcare services and the influencing factors among the women expecting additional childbirth in Jiading District， Shanghai， and to provide references for promoting the utilization of preconception healthcare services under the new population policy. MethodsA questionnaire survey on the utilization of preconception healthcare services and related influencing factors was carried out among 682 women expecting additional childbirth across six subdistricts in Jiading District， Shanghai. The results were statistically analyzed. ResultsThe average age of the women was （31.7±4.5） years， 30.2% of whom were ≥35 years old. The proportion of women having their third or subsequent children was low， at 16.4%. A significant majority， 92.4%， were found to have various risk factors during initial pregnancy screening. The utilization rate of preconception healthcare services among women seeking additional childbirth was relatively low at 26.7%. Awareness of the free preconception check-up program in Jiading District was also low at 28.6%， and the utilization rate for these services was even lower at 7.69%. Unplanned pregnancies were the primary reason for not utilizing preconception healthcare services， accounting for 63.6%. The results of multifactorial binary logistic regression analysis showed that the utilization rate of preconception healthcare services before the current pregnancy was higher for women aged between 35 and 39 compared to women aged ≤29 years old （OR=1.789， 95%CI： 1.033‒3.099）. Women with planned pregnancies had a higher utilization of preconception healthcare services prior to this pregnancy （OR=4.164， 95%CI： 2.627‒6.602）. Women who had received preconception care prior to their first birth had a higher utilization rate of preconception care prior to the current pregnancy （OR=7.534， 95%CI： 4.954‒11.456）. Women without a family history of chronic diseases had a higher utilization rate of preconception healthcare services （OR=1.903， 95%CI： 1.083‒3.345）. ConclusionUnder the context of three-child policy， the proportion of women seeking three or more children in Jiading District is low. Most of these women have risk factors identified during initial pregnancy screenings. The utilization rate of preconception healthcare services and the awareness of the free preconception screening program in Jiading District are both low. Unplanned pregnancies remain the primary reason for failing to receive timely preconception healthcare services. Age， whether the pregnancy was planned， whether the women had received preconception healthcare services before their first baby and family history of chronic diseases are the main factors affecting the utilization of preconception healthcare services. Relevant departments should enhance the promotion of preconception healthcare service programs， especially for women of childbearing age who have not yet given birth， so as to improve the utilization rate of preconception health care services.

Objective To explore the risk factors of central venous catheter related thrombosis in the patients undergoing gastrointestinal tract surgery,and to construct a risk prediction model based on machine learning algorithms.Methods A total of 385 patients receiving gastrointestinal tract surgery and central ve-nous catheter indwelling in this hospital from May 2018 to March 2024 were selected as the study subjects and divided into the thrombus group(n=62)and non-thrombus group(n=323)based on whether or not the catheter-related thrombosis forming.The age,body mass index(BMI),comorbidities,current tumors,neutro-phil/lymphocyte ratio(NLR),surgery time,catheterization vein,systemic immune inflammation index(SII),D-dimer and catheter indwelling time of the patients were collected,and the differences in baseline data were compared between the two groups.The research subjects were randomly divided into the training set and tes-ting set by a 7∶3 ratio.Based on the training set,the logistics regression model,random forest,support vector machine,decision tree and naive Bayes risk prediction models were established.The area under the operating characteristic curve(AUC),accuracy,sensitivity,specificity and F1 value in predicting catheter-related throm-bosis were compared among different models in the testing set.The importance of the predictive factors in the best prediction model conducted the visualized ranking.Results There were statistically significant differences in the proportion of tumor patients,NLR,surgical time and D-dimer level in the baseline data between the two groups(all P＜0.05).The AUC values of the five risk prediction models from great to small were the random forest(0.773),logistics regression model(0.734),support vector machine(0.680),naive Bayes(0.666)and decision tree(0.650).Among them,the accuracy(0.853),sensitivity(0.599),specificity(0.877)and F1 val-ue(0.414)of the random forest model were the highest.D-dimer,surgery time,current tumor and NLR were the top four important predictive factors in the random forest model.Conclusion The constructed random forest model for central venous catheter-related thrombosis in the patients undergoing gastrointestinal tract surgery demonstrates good performance,and the D-dimer,surgery time,current tumor and NLR are the main predictive factors.

Objective To explore the characteristic elements of post competence of nursing staff in large surface ships medical support,and to provide reference for the special training within military hospital and training for dispatched nursing staff.Methods Sixteen medical people who have carried out the large surface ship medical support were selected as research objects using the purposive sampling method.One-to-one semi-structured interviews were performed.The Colaizzi phenomenological analysis was used to carefully sort out and analyze the obtained data and summarize the theme.Results The core competency characteristics of nursing staff during the large surface ships medical support were extracted,including four elements:professional knowledge of common diseases on ships,professional nursing skills on ships,rescue professional ability in ships,and military quality.Conclusion It is essential to construct nursing staff training,system based on the core competencies of large surface ships medical support,and to reserve military nursing talents in daily training,so as to complete medical support tasks with high standards.

Objective To analyze the curative effect of suspended airless laparoscopic surgery on inguinal hernia in children.Methods 180 children with inguinal hernia who received treatment at the Fourth Affiliated Hospital of Guangzhou Medical University from June 2020 to February 2023 were selected.Random number table method was used to divide the patients into two groups,90 cases in each group.The control group underwent laparoscopic high ligation of hernia sac,the observation group was treated with suspended airless laparoscopic surgery,and the clinical efficacy and surgical situation,postoperative pain and stress index levels,as well as the impact on testicular volume and quality of life,complications,and recurrence rate were compared between the two groups.Results There was no statistically significant difference in clinical efficacy between the two groups of children(P＞0.05).The surgical performance of the observation group was better than that of the control group(P＜0.05).The scores of the simplified McGill pain questionnaire were(23.23±5.11)points and(25.51±5.21)points in the observation group and control group 12 hours after surgery,and(20.02±4.55)points and(22.73±4.46)points on the first day after surgery,respectively.3 days after surgery,the scores were(11.76±1.71)points and(12.63±1.82)points,respectively,and the difference between the two groups was statistically significant(P＜0.05).On the second day after surgery,the elevated levels of stress indicators such as interleukin-6(IL-6),interleukin-10(IL-10),cortisol(Cor),and malondialdehyde(MDA)in the observation group were lower than those in the control group[(29.03±4.21)ng/L vs(30.86±4.15)ng/L,(30.12±4.23)ng/L vs(32.02±4.41)ng/L,(47.11±6.63)mmol/L vs(50.17±6.71)mmol/L,(24.31±5.18)μmol/L vs(26.63±5.25)pmol/L](all P＜0.05).There was no statistically significant difference in testicular volume between the two groups(P＞0.05),while the quality of life score of the observation group was lower than that of the control group(P＜0.05).The incidence and recurrence rates of complications such as scrotal edema and inguinal pain in the observation group were not statistically significant compared to the control group(P＞0.05),but the subcutaneous emphysema rate in the observation group was lower than that in the control group(P＜0.05).Conclusion Suspended gasless laparoscopic surgery and laparoscopic high ligation of hernia sac have good therapeutic effects in treating pediatric inguinal hernia,while the former has advantages in reducing postoperative pain and stress response.

A 10-year follow-up case of aldosterone and cortisol-secreting adrenocortical carcinoma, a rare disease presenting as an adrenal space-occupying lesion accompanied with hypertension and hypokalemia was reported, and the medical record was investigated in detail. Through case presentation and literature review, it was noted that patients with adrenocortical carcinoma presented a difference in clinical manifestations, pathology, and biological behaviors. This paper may help clinicians enhance their understanding of adrenocortical carcinoma. Especially significant adrenal space-occupying lesions highly suspicious of recurrence and producing different types of endocrine hormones should be paid more attention.