ObjectiveTo explore ethical dilemmas in amputation treatment, focusing on patient autonomy, informed consent and decision-making interaction between family members and medical teams, to provide references for clinical ethical decision-making and rehabilitation practice. MethodsThe decision-making process of amputation was analyzed from three dimensions, including patient autonomy, informed consent and shared decision-making of families and medical teams, in light of ethical principles such as non-maleficence, beneficence and justice. ResultsEthical decision-making in amputation was based on adequate informed consent of patients and their families. Medical teams made decisions on the premise of respecting patients' true will. Postoperative psychological support and social security system played a vital role in patients' rehabilitation, and national policy support was indispensable. ConclusionEthical decision-making for amputation should balance the responsibilities of medical teams and family participation on the basis of respecting patient autonomy and ensuring informed consent. Sound postoperative psychological support and social security system are essential for patients' comprehensive rehabilitation, which should be fully considered in clinical ethical practice.

Palliative care has become an important medical measure to provide professional healthcare and alleviate patients' suffering. Nurse-led palliative care models enable patients to access palliative care services in a timely manner and can be applied across various healthcare settings. This paper reviews the current status of nurse-led palliative care models in China and internationally, summarizes the summarizes the intervention settings, care forms, implementation contents, and effects of nurse-led palliative care models, and expounds on the existing barriers and improvement strategies of nurse-led palliative care models in China. The aim is to provide a reference for the implementation and development of palliative care.

The aim of this study is to determine the effects of Inonotus obliquus polysaccharides on the main organs and hormones of male mice infected with Neosporidium.The animal model of neosporidiosis in BALB/c mice was established.After intragastric administration,the pathological changes of brain,liver and spleen were observed by histopathology,the worm load in brain,liver and spleen was detected by qPCR,and the levels of FSH,LH and T4 in serum of male mice were detected by ELISA.The results showed that compared with the blank control group,granular spherical lesions could be seen in the brain tissue of mice in the model group,with patchy necrosis of hepatocytes,splenic hemorrhage,red pulp hyperemia and a large number of red blood cell infil-tration.Inonotus obliquus polysaccharides can improve the injury of brain,liver,spleen and other organs and tissues.The worm load in the brain of the Inonotus obliquus polysaccharide group was significantly lower than that of the model group on the 14th day and 21st day(P＜0.01),and that of the liver and spleen on the 21st day was significantly lower than that of the model group(P＜0.01).The level of FSH in the model group and Inonotus obliquus polysaccharide group was signif-icantly lower than that in the blank control group(P＜0.05 or P＜0.01),while that in the Inono-tus obliquus polysaccharide group was significantly higher than that in the model group(P＜0.05 or P＜0.01).The level of LH in the model group was significantly higher than that in the blank control group(P＜0.01),while that in the Inonotus obliquus polysaccharide group was significant-ly higher than that in the blank control group on the 7th day and 42nd day(P＜0.05).There was significant difference in T4 level between the model group and the blank group(P＜0.05 or P＜0.01),while the Inonotus obliquus polysaccharide group was similar to the blank control group on the 21st and 35th day(P＞0.05).Inonotus obliquus polysaccharides can improve the damage of Neosporidium on brain,liver and spleen of male rats,reduce the insect load in brain,liver and spleen,regulate the levels of FSH,LH and T4 hormones,and maintain the stability of reproductive system.

Palliative care has become an important medical measure to provide professional healthcare and alleviate patients' suffering. Nurse-led palliative care models enable patients to access palliative care services in a timely manner and can be applied across various healthcare settings. This paper reviews the current status of nurse-led palliative care models in China and internationally, summarizes the summarizes the intervention settings, care forms, implementation contents, and effects of nurse-led palliative care models, and expounds on the existing barriers and improvement strategies of nurse-led palliative care models in China. The aim is to provide a reference for the implementation and development of palliative care.

Objective The present study aims to explore the mediating role of rumination and coping styles in social support and post-traumatic stress disorder(PTSD)in young and middle-aged spinal cord injury(SCI)patients.The study will provide a basis for developing targeted interventions.Methods Two hundred and forty young and middle-aged SCI patients hospitalized for treatment were selected by convenience sampling and questionnaires were administered using the General Information Questionnaire,the Perceived Social Support Scale(PSSS),the Simplified Coping Style Questionnaire(SCSQ),the Event Related Rumination Inventory(ERRI),and the Post-traumatic Stress Disorder Self-assessment Scale(PCL-C),Mediation analysis using Model-6 with Process4.1 plugin in SPSS 25.0.Results The mean scores for PTSD,social support,rumination,positive coping,and negative coping in young and middle-aged SCI patients were 29.00(26.00,35.75),67.00(62.00,70.00),and 37.00(34.00,4 1.00),and 36.00(33.00,42.00),respectively.PTSD demonstrated a negative correlation(r=-0.553,r=-0.484,P＜0.001)and a negative correlation with positive coping and rumination(r=0.499,r=0.472,P＜0.001).The mediation modelling test demonstrated that rumination and positive and negative coping mediated significantly between social support and PTSD,with effect values of-0.078 1,-0.097 0 and-0.049 6,accounting for 17.81％,22.12％and 11.31％of the total effect,respectively.Furthermore,the chain mediation effects of rumination and positive coping and negative coping were also significant,with effect values of-0.026 3 and-0.026 2,accounting for 5.99％and 5.97％of the total effect,respectively.Conclusions The present study hypothesises that rumination,thinking and coping styles play a simple and chain-mediating role between social sup-port and PTSD in young and middle-aged SCI patients.Medical professionals should focus on the mediating role of rumination and coping styles when developing interventions related to improving and preventing PTSD in patients,which can be done by increasing the level of social support for patients,decreasing the level of rumination,and guiding patients to positively cope with their illness.

Objective The present study aims to explore the mediating role of rumination and coping styles in social support and post-traumatic stress disorder(PTSD)in young and middle-aged spinal cord injury(SCI)patients.The study will provide a basis for developing targeted interventions.Methods Two hundred and forty young and middle-aged SCI patients hospitalized for treatment were selected by convenience sampling and questionnaires were administered using the General Information Questionnaire,the Perceived Social Support Scale(PSSS),the Simplified Coping Style Questionnaire(SCSQ),the Event Related Rumination Inventory(ERRI),and the Post-traumatic Stress Disorder Self-assessment Scale(PCL-C),Mediation analysis using Model-6 with Process4.1 plugin in SPSS 25.0.Results The mean scores for PTSD,social support,rumination,positive coping,and negative coping in young and middle-aged SCI patients were 29.00(26.00,35.75),67.00(62.00,70.00),and 37.00(34.00,4 1.00),and 36.00(33.00,42.00),respectively.PTSD demonstrated a negative correlation(r=-0.553,r=-0.484,P＜0.001)and a negative correlation with positive coping and rumination(r=0.499,r=0.472,P＜0.001).The mediation modelling test demonstrated that rumination and positive and negative coping mediated significantly between social support and PTSD,with effect values of-0.078 1,-0.097 0 and-0.049 6,accounting for 17.81％,22.12％and 11.31％of the total effect,respectively.Furthermore,the chain mediation effects of rumination and positive coping and negative coping were also significant,with effect values of-0.026 3 and-0.026 2,accounting for 5.99％and 5.97％of the total effect,respectively.Conclusions The present study hypothesises that rumination,thinking and coping styles play a simple and chain-mediating role between social sup-port and PTSD in young and middle-aged SCI patients.Medical professionals should focus on the mediating role of rumination and coping styles when developing interventions related to improving and preventing PTSD in patients,which can be done by increasing the level of social support for patients,decreasing the level of rumination,and guiding patients to positively cope with their illness.

Objective To compare the efficacy and safety of computed tomography (CT)-guided percutaneous versus electromagnetic navigation bronchoscopy (ENB)-guided microwave ablation (MWA) for the treatment of pulmonary nodules. Methods A retrospective analysis was conducted on the data of high-risk pulmonary nodule patients who underwent MWA at the Nanjing Drum Tower Hospital between 2022 and 2023. The pathological diagnosis rate, complications, and progression-free survival (PFS) rate were compared between the CT group and the ENB group. Results There were 61 patients in the CT group, including 30 males and 31 females, with an average age of (67.22±9.13) years. There were 53 patients in the ENB group, including 29 males and 24 females, with an average age of (65.29±13.76) years. The pathological diagnosis rate in the CT group was slightly higher than that in the ENB group (88.52% vs. 71.69%, P=0.03). However, the ENB group exhibited a lower incidence of perioperative complications, including pneumothorax (16.39% vs. 3.77%, P=0.03), hemoptysis (19.67% vs. 5.66%, P=0.05), and pain (22.95% vs. 7.55%, P=0.03). There was no statistically significant difference in PFS rate between the two groups [HR=1.17, 95%CI (0.23, 5.81), P=0.85]. Conclusion Both CT-guided and ENB-guided MWA are effective treatment modalities for high-risk pulmonary nodules.

The aim of this study is to determine the effects of Inonotus obliquus polysaccharides on the main organs and hormones of male mice infected with Neosporidium.The animal model of neosporidiosis in BALB/c mice was established.After intragastric administration,the pathological changes of brain,liver and spleen were observed by histopathology,the worm load in brain,liver and spleen was detected by qPCR,and the levels of FSH,LH and T4 in serum of male mice were detected by ELISA.The results showed that compared with the blank control group,granular spherical lesions could be seen in the brain tissue of mice in the model group,with patchy necrosis of hepatocytes,splenic hemorrhage,red pulp hyperemia and a large number of red blood cell infil-tration.Inonotus obliquus polysaccharides can improve the injury of brain,liver,spleen and other organs and tissues.The worm load in the brain of the Inonotus obliquus polysaccharide group was significantly lower than that of the model group on the 14th day and 21st day(P＜0.01),and that of the liver and spleen on the 21st day was significantly lower than that of the model group(P＜0.01).The level of FSH in the model group and Inonotus obliquus polysaccharide group was signif-icantly lower than that in the blank control group(P＜0.05 or P＜0.01),while that in the Inono-tus obliquus polysaccharide group was significantly higher than that in the model group(P＜0.05 or P＜0.01).The level of LH in the model group was significantly higher than that in the blank control group(P＜0.01),while that in the Inonotus obliquus polysaccharide group was significant-ly higher than that in the blank control group on the 7th day and 42nd day(P＜0.05).There was significant difference in T4 level between the model group and the blank group(P＜0.05 or P＜0.01),while the Inonotus obliquus polysaccharide group was similar to the blank control group on the 21st and 35th day(P＞0.05).Inonotus obliquus polysaccharides can improve the damage of Neosporidium on brain,liver and spleen of male rats,reduce the insect load in brain,liver and spleen,regulate the levels of FSH,LH and T4 hormones,and maintain the stability of reproductive system.

Objective To investigate the diagnostic value of photoplethysmography (PPG) in the detection of obstructive sleep apnea syndrome (OSAS) among critically ill patients with respiratory or cardiocerebrovascular diseases accompanied by snoring. Methods A total of 91 critically ill patients with respiratory or cardiocerebrovascular diseases accompanied by snoring, admitted to the internal medicine ward of Subei People's Hospital from January 2019 to October 2023 were enrolled. After informed consent, overnight polysomnography (PSG) and PPG were performed. The consistency of the sleep apnea parameters obtained of the two methods by sensitivity, specificity, positive predictive value, negative predictive value, and the area under the receiver operating characteristic (ROC) curve. Results There were no statistically significant differences in apnea-hypopnea index (AHI), total sleep time, lowest oxygen saturation, and time with oxygen saturation below 90% between PPG and PSG (P>0.05). When AHI≥ 5 times/h and AHI≥15 times/h, the diagnostic sensitivity of the patients in this group was 94.37% and 93.10%, respectively, with specificities of 73.68% and 90.91%, positive predictive values of 91.78% and 94.74%, and negative predictive values of 77.78% and 88.23%, and areas under the ROC curves were 0.961 and 0.982, respectively. For critically ill patients with respiratory diseases, the diagnostic sensitivity was 89.29% and 87.10%, respectively, with specificities of 84.62% and 80.00%, positive predictive values of 92.59% and 93.10%, and negative predictive values of 78.57% and 72.72%, and the areas under the ROC curves were 0.978 and 0.987, respectively. For critically ill patients with cardiocerebrovascular diseases, the diagnostic sensitivity was 87.18% and 90.32%, respectively, with specificities of 83.33% and 89.47%, positive predictive values of 91.89% and 99.63%, and negative predictive values of 78.57% and 85.56%, and the areas under the ROC curves were 0.942 and 0.986, respectively. Conclusion PPG monitoring results show high consistency with PSG in critically ill patients with respiratory and cardiocerebrovascular diseases combined with OSAS.

Objective To study the effects of radiation on the morphology,function,and NLRP3 expression of mouse salivary gland tissue,and provide new ideas to repair radiation-induced damage to salivary gland tissue.Methods We established a mouse model of radiation-induced submandibular gland injury and Recorded the weight of drinking water.The salivary flow rate was assessed,and HE staining was used to observe submandibular gland injury.Immunohistochemistry and Real-time PCR were used to assess expression of NLRP3 and Caspase-1 in the radiation-injured submandibular gland of mice at 1,3,7 and 14 days after radiation exposure.Results Over time,the amount of water consumed by radiation group mice was gradually increased,the salivary flow rate was decreased,and inflammatory cells in the submandibular gland continued to increase.Acinar cells gradually showed lesions,such as nuclear pyknosis and vacuolization.At 7 and 14 days after radiation exposure,expression levels of NLRP3 and Caspase-1 proteins and genes in the radiation group were significantly higher than those in the normal group(P＜0.05).Conclusions Radiation damages mouse submandibular gland tissue and activates the NLRP3 inflammasome to increase its expression level.