Patients with lacunar infarction (LI) have a higher risk of stroke recurrence compared to other types of stroke, and it is an important pathological basis for vascular dementia. Homocysteine (Hcy) is closely associated with the occurrence and development of LI. The mechanism by which Hcy causes LI involves multiple complex biological processes (including inflammation, oxidative stress, endothelial dysfunction, etc.) and synergistic effects with various risk factors (such as hypertension and hyperglycemia), but the specific mechanism is currently not fully elucidated.

The traditional diagnosis and treatment mode of ischemic stroke faces challenges such as limited diagnostic time window, insufficient drug targeting, and difficulty in penetrating the blood-brain barrier. Nanomaterials, with their unique physicochemical properties and biological effects, provide innovative solutions for precise diagnosis and treatment. In terms of diagnosis, targeted thrombus nanoprobes constructed from nanomaterials, combined with MRI or CT, can achieve high sensitivity and visual detection of thrombi. The development of nano-biosensors has significantly improved the detection efficiency and accuracy of specific biomarkers for ischemic stroke. In terms of treatment, nano-drug carrier systems can efficiently load thrombolytic drugs and promote their penetration of the blood-brain barrier, achieving targeted delivery. Biomimetic nanoparticles effectively promote angiogenesis and neurological function repair in ischemic brain regions by regulating inflammation and oxidative stress. This article systematically reviews the application progress of nanomaterials in the diagnosis and treatment of ischemic stroke, aiming to provide a basis for promoting the translation of nanotechnology from basic research to clinical practice, and to provide new ideas for precise diagnosis and treatment of ischemic stroke.

Objective To explore the effectiveness of the diffusion of innovation theory in com-bination with multidisciplinary nursing collaboration in intervention for patients with severe pneumonia complicated by heart failure.Methods A total of 120 patients with severe pneumonia complicated by heart failure admitted between April 2021 and April 2024 were enrolled and randomly divided into observation group(n=60)and control group(n=60)using a random black-and-white ball method.The control group received conventional nursing intervention,while the observation group received an intervention model combining the diffusion of innovations theory with multidisciplinary collaboration on top of the conventional nursing.Rehabilitation outcomes(time to control of pulmonary inflammation,time to resolution of cough and expectoration,length of hospital stay)and post-intervention cardiac function[left ventricular ejection fraction(LVEF),left ventricular end-systolic volume(LVESV)]were compared between the two groups.The Minnesota Living with Heart Failure Questionnaire(MLHFQ)was used to assess quality of life,and the Self-Care Heart Failure Index(SCHFI)was used to evaluate self-care behaviors.Complications were compared between the two groups,and cost-effectiveness was analyzed(patient medical expenses and re-hospitalization rates).Results The observation group had shorter time to resolution of cough and expectoration,control of pulmonary inflammation,and length of hospital stay compared with the control group,with statistically significant differences(P＜0.05).After intervention,LVEF increased in both groups compared with pre-intervention lev-els,and was higher in the observation group than in the control group,with a statistically significant difference(P＜0.05);ESV decreased in both groups compared with pre-intervention levels,and was lower in the observation group than in the control group,with a statistically significant difference(P＜0.05).After intervention,physiological,emotional,and social functioning scores in the MLHFQ decreased in both groups compared with pre-intervention levels,and were lower in the ob-servation group than in the control group,with statistically significant differences(P＜0.05).After intervention,scores for self-care maintenance,self-care management,and self-care confidence in the SCHFI increased in both groups,and were higher in the observation group than in the control group,with statistically significant differences(P＜0.05).There was no statistically significant difference in the incidence of complications between the two groups(P＞0.05).Conclusion The combination of the diffusion of innovations theory and multidisciplinary collaboration nursing model can accelerate the rehabilitation process in patients with severe pneumonia complicated by heart fail-ure,improve their quality of life,and effectively enhance their self-care abilities.

AIM:To investigate and analyze the current situation and needs of clinical research nurses in China,in order to provide scientific basis for constructing a training system for research nurs-es,promoting standardized training,and achieving standardized management for them.METHODS:A self-made questionnaire was used to investigate 102 research nurses from nearly 70 well-known clinical trial institutions in China.The contents of the questionnaire mainly included the general infor-mation,professional experience and work content of the research nurses,the sense of accomplish-ment and training needs of clinical trial work.RE-SULTS:Among the 102 research nurses surveyed,92.15％have a bachelor's degree or above;53.92％of those have intermediate or higher professional titles;74.51％of them are part-time research nurse.Among professional experiences,19.61％have more than 10 years of clinical trial experience;47.06％,40.20％,and 21.17％of surveyed research nurses were authorized to participate in clinical tri-al drug management,sample management,and quality control;70.59％of research nurses have a high sense of achievement in their daily work.In terms of education and training needs,clinical trial related laws and regulations,standardized training for clinical trial protocol implementation,and good clinical practice(GCP)are the three most important aspects.CONCLUSION:Clinical research nurses in China have a relatively high level of education and nursing experience,but there is still a large gap in the amount of professional full-time clinical re-search nurses in China.Due to the rapid develop-ment of innovative drugs and devices,as well as the urgent need to improve the clinical research system,it is necessary to establish a training,as-sessment,and evaluation system for research nurs-es that is in line with China's national conditions in order to improve the professional level of research nurses,and improve the quantity and quality of clinical trial research on innovative drugs and devic-es in China.

OBJECTIVE To establish a comprehensive platform for regional pharmaceutical care among Jiangxi provincial pediatric alliance to realize the management of pediatric hierarchical diagnosis and treatment, and improve the quality of pharmaceutical care. METHODS A unified diagnosis and treatment information standard and a knowledge base of children's rational drug use rules were established among the medical institutions of Jiangxi provincial pediatric alliance. On this basis, the medical records and drug use information of patients in various medical institutions in the region were uploaded to the chain in a structured manner in real time, and a comprehensive platform for regional pharmaceutical care was built. RESULTS The comprehensive platform for regional pharmaceutical care built based on blockchain technology could share medical resources and information among medical institutions, realize rational drug use management, remote prescription review, individualized drug use guidance, popular science education, government supervision, etc., and improve the quality of pharmaceutical care. CONCLUSION The comprehensive platform for regional pharmaceutical care among Jiangxi provincial pediatric alliance can help allocate high-quality medical resources (drug safety knowledge base and pediatric pharmacists) for primary medical institutions. Further more, it lays the foundation for government supervision at the same time ensuring children’s medication safety, which has great practical significance.

AIM: To investigate and analyze the current situation and needs of clinical research nurses in China, in order to provide scientific basis for constructing a training system for research nurses, promoting standardized training, and achieving standardized management for them. METHODS:A self-made questionnaire was used to investigate 102 research nurses from nearly 70 well-known clinical trial institutions in China. The contents of the questionnaire mainly included the general information, professional experience and work content of the research nurses, the sense of accomplishment and training needs of clinical trial work. RESULTS: Among the 102 research nurses surveyed, 92.15% have a bachelor's degree or above; 53.92% of those have intermediate or higher professional titles; 74.51% of them are part-time research nurse. Among professional experiences, 19.61% have more than 10 years of clinical trial experience; 47.06%, 40.20%, and 21.17% of surveyed research nurses were authorized to participate in clinical trial drug management, sample management, and quality control; 70.59% of research nurses have a high sense of achievement in their daily work. In terms of education and training needs, clinical trial related laws and regulations, standardized training for clinical trial protocol implementation, and good clinical practice (GCP) are the three most important aspects. CONCLUSION: Clinical research nurses in China have a relatively high level of education and nursing experience, but there is still a large gap in the amount of professional full-time clinical research nurses in China. Due to the rapid development of innovative drugs and devices, as well as the urgent need to improve the clinical research system, it is necessary to establish a training, assessment, and evaluation system for research nurses that is in line with China's national conditions in order to improve the professional level of research nurses, and improve the quantity and quality of clinical trial research on innovative drugs and devices in China.

Objective To sort out and summarize the research hotspots and trends of Chinese medicine nursing technolo-gy at the present stage.Methods We searched the research literature on TCM nursing technology included in China Knowledge,Wanfang,and Wipu build-up to November 30,2023,and used CiteSpace 6.1.R6 software to perform co-occurrence analysis of research institutions and keyword clustering,timeline,and emergence analysis.Results A total of 5 771 documents were in-cluded,with a general upward trend in the number of publications,peaking at 692 publications in 2021.5 206 documents from 673 journals were included in the research literature,of which 19 journals had ≥50 publications(35.47％).2 087 research or-ganizations were involved,of which 27 had ≥20 publications(13.24％).Involving 9 484 authors,there were a total of 8 au-thors ≥5 in the cluster,indicating the existence of stable teamwork in the cluster.The keyword co-occurrence analysis yielded the research hotspots of TCM nursing technology as TCM nursing,training,nursing management,clinical efficacy,complica-tions,and quality of life.Conclusion Based on the econometrics and visualization analysis of the literature on TCM nursing technology,we explored the research hotspots and trends in this field,and provided two theoretical paths for medical institution managers to construct and optimize the management system of TCM nursing technology:to standardize the TCM nursing technology in hospitals and establish a clinical access management system;and based on the multidimensional management method,to inno-vate the training system of TCM nursing technology.

Objective To compare the clinical efficacy of three different therapies,including transjugular intrahepatic portosystemic shunt(TIPS)treatment,endoscopic treatment and medication treatment,combined with transhepatic arterial chemoembolization(TACE)in treating primary liver cancer complicated by portal hypertension and upper gastrointestinal bleeding.Methods A total of 105 patients with primary liver cancer associated with portal hypertension and upper gastrointestinal bleeding,who were admitted to the No.980 Hospital of PLA Joint Logistics Support Forces of China to receive treatment between January 2014 and June 2020,were enrolled in this study.According to the therapeutic scheme,the patients were divided into TIPS+TACE group(TIPS group,n=25),endoscopy+TACE group(endoscopy group,n=30),and medication+TACE group(medication group,n=50).The clinical efficacy,recurrence rate of bleeding,incidence of hepatic encephalopathy,and survival rate were compared between each other among the three groups.Results The differences in the postoperative 6-month,12-month and 24-month recurrence rates of bleeding between each other among the three groups were statistically significant(all P＜0.05).In TIPS group,the portal vein pressure decreased from preoperative(38.47±9.35)mmHg(1 mmHg=0.133 kPa)to postoperative(25.24±5.68)mmHg,the difference was statistically significant(P＜0.05).After treatment,the hemoglobin level in the three groups showed varying degrees of elevation,which in the TIPS group and endoscopy group were better than that in the medication group,the differences were statistically significant(P＜0.05).In all three groups,the differences in the recurrence rate of bleeding between postoperative 6-month value,12-month value and 24-month value were statistically significant(all P＜0.05).The postoperative 6-month,12-month and 24-month recurrence rates of bleeding in the TIPS group were lower than those in the endoscopy group and the medication group,and the differences were statistically significant(P＜0.05).The postoperative 12-month and 24-month recurrence rates of bleeding in the TIPS group were lower than those in the endoscopy group,and the differences were statistically significant(P＜0.05).The postoperative 12-month and 24-month recurrence rates of bleeding in the endoscopy group were lower than those in the medication group(P＜0.05),and the difference in the postoperative 6-month recurrence rate of bleeding between the two groups was not statistically significant(P＞0.05).The postoperative 6-month and 12-month incidences of hepatic encephalopathy in the TIPS group were higher than those in the endoscopy group and the medication group,the differences were statistically significant(P＜0.05),while the differences in the postoperative 6-month and 12-month incidences of hepatic encephalopathy between the endoscopy group and the medication group were not statistically significant(P＞0.05),and the differences in the postoperative 24-month incidence of hepatic encephalopathy between each other among the three groups were not statistically significant(P＞0.05).No statistically significant difference in the 6-month mortality existed between TIPS group and endoscopy group(P＞0.05),and the 6-month mortality of both TIPS group and endoscopy group was remarkably lower than that of the medication group(P＜0.05).The postoperative 12-month mortality and 24-month mortality in TIPS group were lower than those in the endoscopy group and the medication group,and the differences were statistically significant(P＜0.05),but the differences in the postoperative 12-month mortality and 24-month mortality between the endoscopy group and the medication group were not statistically significant(P＞0.05).Conclusion For primary liver cancer associated with portal hypertension and upper gastrointestinal bleeding,TIPS combined with TACE can effectively control tumor progression and prolong survival.(J Intervent Radiol,2024,32:33-37)

Objective By using the computational fluid mechanic(CFD)method the tandem carotid artery stenosis(TCAS)was simulated on the model,and to compare the postoperative hemodynamic changes of different surgical procedures.Methods One patient with tandem stenosis of internal carotid artery(ICA)and common carotid artery(CCA)was selected.CFD technique was used to establish four three-dimensional(3-D)models of the carotid bifurcations,including one model of a real patient and three models of presumptive surgery.The hemodynamic analysis was performed with these models so as to explore the development mechanism of TCAS and to discuss the selection of suitable surgical plan.Results In tandem stenosis,the stenosis was preferentially formed in CCA and subsequently led to ICA stenosis.The local hemodynamic situation in TCAS was more complex and more risky than in single carotid artery stenosis.In tandem stenosis,the treatment of one stenosis site would affect the blood flow at the next stenosis site and cause restenosis or plaque rupture.Conclusion In treating patients with TCAS,CFD simulation examination should be performed when the surgical plan is formulated,which can help clinicians to predict the postoperative changes in blood flow and to choose the appropriate surgical plan.

Objective:To explore the protective effect of labor analgesia on pelvic floor muscle function of primipara after vaginal delivery.Methods:A total of 140 cases of primipara with vaginal delivery admitted to the Affiliated Hospital of Jining Medical College from March to August 2022 were selected retrospectively, and they were divided into control group (routine delivery) and observation group (painless delivery) according to the intention of delivery, each group with 70 cases. Labor pain, pelvic floor muscle function score and pelvic floor muscle status at 6 weeks postpartum, Female Sexual Function Scale (FSFI) score at 3 months postpartum and reported postpartum symptoms were compared between the two groups.Results:The scores of Visual Analogue Scale (VAS) at immediately after gastric antral empting, after drinking carbohydrates (5, 30, 60, 120 min) and at full opening of uterine orifice in the observation group were lower than those in control group, there were statistical differences ( P<0.05). At 6 weeks postpartum, the maximum muscle voltage of pelvic floor muscle and the average muscle voltage of continuous contraction of pelvic floor muscle for 60 s in the observation group were higher than those in control group: (20.97 ± 2.64) μV vs. (17.31 ± 2.48) μV, (17.33 ± 3.01) μV vs. (13.42 ± 2.77) μV; the mobility of bladder neck and the hiatus area of levator anal muscle in resting state in the observation group were lower than those in the control group: (27.15 ± 3.55) mm vs. (31.05 ± 4.75) mm, (9.97 ± 2.12)cm 2 vs. (11.57 ± 2.84) cm 2, there were statistical differences ( P<0.05). At 6 weeks postpartum, the scores of static pre-stage, static post-stage, type Ⅰ muscle fiber, type Ⅱ muscle fiber and total scores in the observation group were higher than those in the control group: (67.21 ± 12.54) scores vs. (54.17 ± 10.84) scores, (69.12 ± 14.11) scores vs. (56.47 ± 11.24) scores, (63.54 ± 11.45) scores vs. (50.97 ± 10.74) scores, (57.15 ± 8.15) scores vs. (49.76 ± 6.44) scores, (64.25 ± 12.14) scores vs. (57.84 ± 20.57) scores, there were statistical differences ( P<0.05). At 6 weeks postpartum, the scores of FSFI in the observation group were higher than those in the control group ( P<0.05). The rate of urine leakage, fever and mattress sweat reported in the observation group were lower than those in the control group: 22.86%(16/70) vs. 40.00%(28/70), 15.71%(11/70) vs. 30.00%(21/70), 30.00%(21/70) vs. 47.14%(33/70), there were statistical differences ( χ2 = 4.77, 4.05, 4.34, P<0.05). Conclusions:Labor analgesia can effectively shorten labor process, relieve labor pain and protect pelvic floor muscle function during vaginal labor in primipara.