Objective To explore the efficacy of carotid color Doppler ultrasonography(CDU)combined with transcranial color Doppler ultra sonography(TCCD)in the diagnosis of carotid artery stenosis in elderly patients with acute cerebral infarction(ACI).Methods The clinical data of 306 elderly patients with suspected ACI who were admitted to the Second Affiliated Hospital of Air Force Medical University,and received CDU and TCCD from May 2021 to May 2023 were retrospectively analyzed.The result of digital subtraction angiography(DSA)was taken as the gold standard.The patients were assigned to cerebral infarction group or non-cerebral infarction group according to the gold standard.CDU parameters(peak systolic velocity[PSV]and end diastolic velocity[EDV]of the common carotid artery])and TCCD parameters(resistance index[RI]and pulsatility index[PI]of posterior cerebral artery[PCA])were compared between the two groups.According to the degree of carotid artery stenosis,ACI patients were assigned to mild stenosis subgroup,moderate stenosis subgroup or severe stenosis subgroup.CDU parameters(PSV,EDV)and TCCD parameters(RI,PI)were compared among subgroups.The efficacy of related parameters in the diagnosis of ACI and the degree of carotid artery stenosis was evaluated by receiver operating characteristic(ROC)curve.Results There were 155 patients(50.65%)in the cerebral infarction group and 151 patients(49.35%)in the non-cerebral infarction group.The cerebral infarction group had higher EDV,PSV and RI and lower PI than the non-cerebral infarction group(P＜0.05).The areas under curve(AUC)values of ROC curves of EDV,PSV,RI,PI and their combination in the diagnosis of ACI were 0.577,0.563,0.644,0.643 and 0.726(P＜0.05).The levels of EDV,PSV and RI in the subgroups were as follows:severe stenosis subgroup＞moderate stenosis subgroup＞mild stenosis subgroup,and the change trend of PI was shown as mild stenosis subgroup＞moderate stenosis subgroup＞severe stenosis subgroup(P＜0.05).The AUC values of ROC curves of EDV,PSV,RI,PI and their combination in evaluating the degree of carotid artery stenosis in ACI patients were 0.767,0.802,0.845,0.846 and 0.952(P＜0.05).Conclusion Carotid CDU combined with TCCD can effectively diagnose ACI and carotid artery stenosis,and has high application value for the evaluation of carotid artery stenosis in elderly ACI patients.

Objective:To investigate the disease burden, clinical characteristics and independent risk factors affecting in-hospital outcomes of children with congenital heart disease (CHD) combined with heart failure (HF) in China.Methods:(1) Descriptive study: based on the global burden of disease study 2021, available data on children under 15 years of age with CHD and HF in China from 1990 to 2021 were collected. The prevalence and trends in different age subgroups (<1 year, 1-<2 years, 2-<5 years, 5-<10 years, 10-<15 years) were analyzed, and the annual percentage change (EAPC) was estimated using linear regression. (2) Retrospective cohort study: a total of 1 062 children with CHD and HF from a multicenter study on pediatric HF in China were included. The children were divided into two groups:<2 years group and 2-<18 years group. Data on demographics, clinical features, diagnosis, treatments, and in-hospital outcomes were analyzed. Mann-Whitney U test and chi-square test were used for group comparisons.Multivariable Logistic regression was applied to identify factors influencing outcomes (in-hospital mortality and adverse cardiovascular events). Results:(1) From 1990 to 2021, the number of children with CHD and HF in China increased from 333 000 (95% uncertainty interval ( UI) 271 000-405 000) to 368 000 (95% UI 296 000-459 000), a growth of 10.8% (95% UI 5.0%-16.6%). Concurrently the prevalence rate increased from 104.5 (95% UI 85.1-127.3) per 100 000 to 142.0 (95% UI 114.0-176.8) per 100 000, a growth of 35.9% (95% UI 28.7%-43.0%), with an EAPC of 1.5% (95% CI 1.2%-1.8%). Although the number of cases in the<1 year and 1-<2 years groups decreased by 41.0% and 25.6%, respectively, the prevalence in all age groups showed an upward trend:<1 year EAPC 0.6% (95% CI 0.5%-0.7%); 1-<2 years EAPC 0.9% (95% CI 0.8%-1.0%); 2-<5 years EAPC 1.2% (95% CI 1.0%-1.4%); 5-<10 years EAPC 1.5% (95% CI 1.2%-1.8%); 10-<15 years EAPC 2.1% (95% CI 1.9%-2.3%). (2) The multicenter study revealed that among 1 062 hospitalized children, 528 (49.7%) were male and 534 (50.3%) were female, with the age at admission of 5.4 (2.2,18.2) months. The majority of the children (77.9%, 827/1 062) were under 2 years of age, whereas 22.1% (235/1 062) were aged between 2-<18 years. Children with complex congenital heart defects accounted for the highest proportion (48.6%, 516/1 062), while those with isolated CHD made up 31.5% (335/1 062). Statistically significant differences were observed in several variables in demographics, clinical features, diagnosis, treatments, and outcomes between the two age groups (all P<0.05). The use of renin-angiotensin-aldosterone system inhibitors (41.1%, 436/1 062) and beta-blockers (8.7%, 92/1 062) was lower in hospitalized children with CHD and HF. Logistic regression identified complex CHD ( OR=7.73, 95% CI 2.24-26.63; OR=3.17, 95% CI 1.92-5.23), pulmonary hyperperfusion ( OR=2.15, 95% CI 1.01-4.18; OR=2.00, 95% CI 1.35-2.97), left ventricular ejection fraction<55% ( OR=2.13, 95% CI 1.08-4.21; OR=2.80, 95% CI 1.45-5.56), arterial oxygen partial pressure ( OR=0.99, 95% CI 0.98-0.99; OR=0.99, 95% CI 0.98-0.99), and serum calcium levels ( OR=0.31, 95% CI 0.17-0.58; OR=0.42, 95% CI 0.28-0.62) as independent risk factors for in-hospital mortality and cardiovascular events. Conclusions:The disease burden of CHD combined with HF in China has shown a continuous upward trend from 1990 to 2021, with higher growth rates in older age groups. Complex CHD, pulmonary hyperperfusion, left ventricular ejection fraction <55%, arterial oxygen partial pressure, and serum calcium concentration are independent risk factors for in-hospital mortality and cardiovascular events.

Objective:To explore the latent profiles of work withdrawal behaviors of junior nurses and their relationship with workplace social capital.Methods:Using the convenience sampling method, from July to August 2023, 348 junior nurses from five Class Ⅲ and seven ClassⅡ public hospitals in Ningxia Hui Autonomous Region were selected as the research objects. They were investigated with a General Information Questionnaire, the Work Withdrawal Behavior Scale, and the Workplace Social Capital Scale. Latent profile analysis was used to explore the categories of work withdrawal behaviors of junior nurses, and the differences in workplace social capital levels among junior nurses of different categories were compared.Results:A total of 348 questionnaires were recovered online in this survey, and 342 questionnaires were valid, with a valid rate of 98.3%. The work withdrawal behaviors of 342 junior nurses could be divided into three latent profiles, including 246 junior nurses (71.9%) in the low psychological-low behavioral withdrawal group, 81 junior nurses (23.7%) in the high psychological-low behavioral withdrawal group, and 15 junior nurses (4.4%) in the high psychological-high behavioral withdrawal group. The results of the unordered multinomial Logistic regression analysis showed that gender, whether they love nursing work or not, the average number of night shifts per month, the workplace social capital, and working years were the influencing factors of the work withdrawal behaviors of junior nurses ( P<0.05) . There were statistically significant differences in the workplace social capital among the three categories of junior nurses ( H=83.82, P<0.01) . Conclusions:There are three categories of work withdrawal behaviors among junior nurses, and there are differences in workplace social capital among junior nurses of different categories. Nursing managers should intervene and support junior nurses according to the characteristics of different categories to improve their workplace social capital levels.

Objective:To explore the latent profiles of work withdrawal behaviors of junior nurses and their relationship with workplace social capital.Methods:Using the convenience sampling method, from July to August 2023, 348 junior nurses from five Class Ⅲ and seven ClassⅡ public hospitals in Ningxia Hui Autonomous Region were selected as the research objects. They were investigated with a General Information Questionnaire, the Work Withdrawal Behavior Scale, and the Workplace Social Capital Scale. Latent profile analysis was used to explore the categories of work withdrawal behaviors of junior nurses, and the differences in workplace social capital levels among junior nurses of different categories were compared.Results:A total of 348 questionnaires were recovered online in this survey, and 342 questionnaires were valid, with a valid rate of 98.3%. The work withdrawal behaviors of 342 junior nurses could be divided into three latent profiles, including 246 junior nurses (71.9%) in the low psychological-low behavioral withdrawal group, 81 junior nurses (23.7%) in the high psychological-low behavioral withdrawal group, and 15 junior nurses (4.4%) in the high psychological-high behavioral withdrawal group. The results of the unordered multinomial Logistic regression analysis showed that gender, whether they love nursing work or not, the average number of night shifts per month, the workplace social capital, and working years were the influencing factors of the work withdrawal behaviors of junior nurses ( P<0.05) . There were statistically significant differences in the workplace social capital among the three categories of junior nurses ( H=83.82, P<0.01) . Conclusions:There are three categories of work withdrawal behaviors among junior nurses, and there are differences in workplace social capital among junior nurses of different categories. Nursing managers should intervene and support junior nurses according to the characteristics of different categories to improve their workplace social capital levels.

Objective:To investigate the disease burden, clinical characteristics and independent risk factors affecting in-hospital outcomes of children with congenital heart disease (CHD) combined with heart failure (HF) in China.Methods:(1) Descriptive study: based on the global burden of disease study 2021, available data on children under 15 years of age with CHD and HF in China from 1990 to 2021 were collected. The prevalence and trends in different age subgroups (<1 year, 1-<2 years, 2-<5 years, 5-<10 years, 10-<15 years) were analyzed, and the annual percentage change (EAPC) was estimated using linear regression. (2) Retrospective cohort study: a total of 1 062 children with CHD and HF from a multicenter study on pediatric HF in China were included. The children were divided into two groups:<2 years group and 2-<18 years group. Data on demographics, clinical features, diagnosis, treatments, and in-hospital outcomes were analyzed. Mann-Whitney U test and chi-square test were used for group comparisons.Multivariable Logistic regression was applied to identify factors influencing outcomes (in-hospital mortality and adverse cardiovascular events). Results:(1) From 1990 to 2021, the number of children with CHD and HF in China increased from 333 000 (95% uncertainty interval ( UI) 271 000-405 000) to 368 000 (95% UI 296 000-459 000), a growth of 10.8% (95% UI 5.0%-16.6%). Concurrently the prevalence rate increased from 104.5 (95% UI 85.1-127.3) per 100 000 to 142.0 (95% UI 114.0-176.8) per 100 000, a growth of 35.9% (95% UI 28.7%-43.0%), with an EAPC of 1.5% (95% CI 1.2%-1.8%). Although the number of cases in the<1 year and 1-<2 years groups decreased by 41.0% and 25.6%, respectively, the prevalence in all age groups showed an upward trend:<1 year EAPC 0.6% (95% CI 0.5%-0.7%); 1-<2 years EAPC 0.9% (95% CI 0.8%-1.0%); 2-<5 years EAPC 1.2% (95% CI 1.0%-1.4%); 5-<10 years EAPC 1.5% (95% CI 1.2%-1.8%); 10-<15 years EAPC 2.1% (95% CI 1.9%-2.3%). (2) The multicenter study revealed that among 1 062 hospitalized children, 528 (49.7%) were male and 534 (50.3%) were female, with the age at admission of 5.4 (2.2,18.2) months. The majority of the children (77.9%, 827/1 062) were under 2 years of age, whereas 22.1% (235/1 062) were aged between 2-<18 years. Children with complex congenital heart defects accounted for the highest proportion (48.6%, 516/1 062), while those with isolated CHD made up 31.5% (335/1 062). Statistically significant differences were observed in several variables in demographics, clinical features, diagnosis, treatments, and outcomes between the two age groups (all P<0.05). The use of renin-angiotensin-aldosterone system inhibitors (41.1%, 436/1 062) and beta-blockers (8.7%, 92/1 062) was lower in hospitalized children with CHD and HF. Logistic regression identified complex CHD ( OR=7.73, 95% CI 2.24-26.63; OR=3.17, 95% CI 1.92-5.23), pulmonary hyperperfusion ( OR=2.15, 95% CI 1.01-4.18; OR=2.00, 95% CI 1.35-2.97), left ventricular ejection fraction<55% ( OR=2.13, 95% CI 1.08-4.21; OR=2.80, 95% CI 1.45-5.56), arterial oxygen partial pressure ( OR=0.99, 95% CI 0.98-0.99; OR=0.99, 95% CI 0.98-0.99), and serum calcium levels ( OR=0.31, 95% CI 0.17-0.58; OR=0.42, 95% CI 0.28-0.62) as independent risk factors for in-hospital mortality and cardiovascular events. Conclusions:The disease burden of CHD combined with HF in China has shown a continuous upward trend from 1990 to 2021, with higher growth rates in older age groups. Complex CHD, pulmonary hyperperfusion, left ventricular ejection fraction <55%, arterial oxygen partial pressure, and serum calcium concentration are independent risk factors for in-hospital mortality and cardiovascular events.

Objective To investigate the changes in cerebral hemodynamic parameters in patients with migraine and different grades of patent foramen ovale(PFO)using contrast-enhanced transcranial Doppler(cTCD)foaming test and contrast-enhanced transthoracic echocardiography(cTTE).Methods A total of 85 patients with migraine in our hospital were enrolled,and cTCD and cTTE were used in combination to determine whether a subject had right to left shunt(PFO-RLS)caused by PFO,which was graded according to the grading criteria(grades 0,Ⅰ,Ⅱ,and Ⅲ).Meanwhile,TCD was used to observe the ultrasound parameters of the middle cerebral artery before and after Valsalva maneuver(VM),in-cluding peak systolic blood flow velocity(Vs),mean blood flow velocity(Vm),peak diastolic blood flow velocity(Vd),resistance index,and pulsatility index,and these ultrasound parameters were compared between grade 0 PFO-RLS and grade Ⅰ/Ⅱ/Ⅲ PFO-RLS.Results Among the 85 subjects,13 patients had migraine with grade 0 PFO-RLS,34 patients had migraine with grade I PFO-RLS,17 patients had migraine with grade Ⅱ PFO-RLS,and 21 patients had migraine with grade Ⅲ PFO-RLS.The results before VM showed that compared with the patients with migraine and grade 0 PFO-RLS,the patients with migraine and grade Ⅱ PFO-RLS had significant increases in Vs,Vm,and Vd(P<0.05),and the results after VM showed that compared with the patients with migraine and grade 0 PFO-RLS,the patients with migraine and grade Ⅲ PFO-RLS had significant increases in Vm and Vd(P<0.05).Conclusion There are different changing trends of cerebral blood flow in patients with migraine and different grades of PFO-RLS,and the characteristic changes in cere-bral blood flow can provide a certain clinical theoretical basis for the etiological diagnosis and treatment of patients with mi-graine.

Objective:To evaluate the cerebral blood flow circulation time (CCT) by contrast-enhanced ultrasound, and to explore the change rule of CCT in different degree of intracranial pressure, so as to provide a new method for non-invasive monitoring of intracranial pressure.Methods:Ten patients with hemorrhagic stroke or acute craniocerebral trauma with increased intracranial pressure were selected from Tangdu Hospital, the Air Force Military Medical University from January to December 2019. Contrast-enhanced ultrasound was performed when the invasive intracranial pressure (iICP) increased (>20 mmHg, iICP increased group) and decreased to normal (≤20 mmHg, iICP normal group), CCT was measured and analyzed. The differences of CCTs between different iICP groups were compared and the relationship between CCT and iICP was analyzed.Results:①The CCT on the lesion sides of the same patients in the iICP increased group was significantly longer than in the iICP normal group[(9.34±2.58)s vs (6.48±1.91)s, P=0.002]. ②When iICP was increased in patients with hemorrhagic stroke or acute craniocerebral trauma, the CCTs of the diseased side and the non-pathological side were not statistically significant [(9.34±2.58)s vs (9.01±3.22)s, P=0.809]. ③Pearson correlation analysis and Spearman rank correlation analysis showed that there were no correlations between patient′s breathing, heart rate, carbon dioxide partial pressure, body temperature, GCS score and CCT (all P>0.05). Age, mean arterial pressure and CCT were moderately correlated ( r=0.518, 0.463 and P=0.023, 0.046, respectively). ④Logistic regression analysis showed that CCT was an independent risk factor related to intracranial hypertension( OR=0.7, 95% CI=0.47-0.95, P=0.036). The area under ROC curve (AUC) predicted by logistic regression was 0.750(0.588~0.912). Conclusions:Contrast-enhanced ultrasound noninvasive assessment of CCT can reflect the intracranial pressure in patients with hemorrhagic stroke or acute traumatic brain injury, and CCT has a predictive value for intracranial hypertension. When the patient has limited conditions for invasive intracranial pressure monitoring, or when the invasive monitoring probe is pulled out but still needs to evaluate intracranial pressure, the change of CCT can provide an effective reference for clinical diagnosis and treatment.

To evaluate the accuracy of transcranial color‐code sonography ( TCCS) in non‐invasive assessment of intracranial pressure( ICP ) . TCCS was used to monitor the cerebral hemodynamic parameters of patients with acute severe traumatic brain injury after decompressive craniectomy and make estimation of the non‐invasive intracranial pressure ( ICPtccs) . Methods A total of 91 patients with acute severe traumatic brain injury involved in this retrospective study were divided into the ICP normal group( ≤22 mm Hg ) and the ICP increased group ( ＞22 mm Hg ) . T he correlation and consistency of middle cerebral artery blood flow parameters and ICPtccs with invasive intracranial pressure ( iICP ) were analyzed . According to Glasgow score ( GCS) ,Patients( GCS 3－8) were divided into acute extremely severe traumatic brain injury( GCS 3 －5) and acute severe traumatic brain injury ( GCS 6 －8 ) . A comparison was made of ROC ( ICPtccs) curve and the area under the curve( AUC) between the two groups were cornpared . Results①No statistical differences were found in cerebral hemodynamic parameters between the side with and without decompressive craniectomy in patients with acute severe traumatic brain injury ( all P ＞0 .05 ) . ②M onitored resistive index ( RI) ,pulsatility index ( PI) and ICPtccs between the normal ICP group and the increased ICP group showed statistically significant differences ( all P ＜ 0 .05 ) ,w hile monitored systolic velocity ,diastolic velocity and mean velocity presented no statistically significant difference ( all P ＞0 .05) . T he correlations between RI ,PI with iICP were low ( r＝ 0 .247 ,0 .221 ; all P ＜ 0 .05 ) ,w hile there was a moderate correlation between ICPtccs and iICP( r ＝0 .417 , P ＜0 .001 ) . ③Bland‐Altman plot showed an overestimation of 2 .3 mm Hg ( 95% CI 0 .00－4 .59 mm Hg ) for ICPtccs compared to iICP . ④T he AUC of Glasgow score ( GCS 3－5 and GCS 6－8) in the two groups were 0 .759 ,0 .781 ( all P ＜0 .05) . All the cut‐off points of ICPtccs were 19 mm Hg ,with a sensitivity of 83 .33% ,81 .82% and a specificity of 64 .86% , 75 .68% ,respectively . Pairwise comparison of two AUCs showed no statistical difference ( P ＝ 0 .476) . ICPtccs presented the same ability to estimate ICP in patients with acute severe and extremely severe traumatic brain injury . TCCS could accurately assess the elevation of ICP in 72 .52% patients with acute severe traumatic brain injury . Conclusions TCCS can be used as a non‐invasive screening tool to assess w hether ICP of patients with acute severe traumatic brain injury is elevated and to semi‐quantitatively estimate ICP ,showing useful clinical value .

Objective To investigate the effect and mechanism of oxycodone on the treatment of cancerous neuropathic pain in advanced colon cancer.Methods 80 cases of advanced colon cancer in department of anorectal of Shaoxing Second Hospital of Zhejiang Province from March 2015 to March 2016 were selected and randomly divided into two groups with 40 cases in each group.The control group were treated with routine clinical treatment, and the experiment group were treated with oxycodone treatment on the basis of the control group.The levels of pain score, quality of life score, serum β-EP, calcitonin gene related peptide (CGRP) and prostaglandin E2(PGE2), clinical efficacy and adverse reaction incidence rate changes were compared between two groups before and after treatment.Results Compared with before treatment, levels of the pain score, serum β-EP, CGRP and PGE2 decreased in two groups after treatment, after treatment, the experiment group pain score (2.38 ±0.34), quality of life score (28.39 ± 3.97), serumβ-EP (228.71 ±34.92), CGRP (22.46 ±3.15), PGE2 level (2.45 ±0.35) and the incidence of adverse reactions was 17.50%, were lower than that of the control group the pain score (3.51 ±0.51), the quality of life score (33.53 ±4.76), serum β-EP (246.67 ±34.83), CGRP (30.36 ±4.25), PGE2(3.36 ±0.47) and the incidence of adverse reactions was 40.00%, the difference was statistically significant (P<0.05), the total effective rate of the experiment group was 87.50%, higher than that of the control group, the total effective rate was 60.00%, the difference was statistically significant (P<0.05).Conclusion Oxycodone can effectively reduce pain in patients with advanced colon cancer neuropathic pain score, improve the quality of life, and has high clinical efficacy and safety.

Nuclear factor erythroid-2 related factor 2 ( Nrf2 ) is an important nuclear transcription factor which protects cells a-gainst oxidative stress injury. Upon exposure to reactive oxygen species ( ROS) or electrophilic stress, Nrf2 can translocate into the nucleus, and then bind to the antioxidant response element ( ARE) , regulating the expression of several antioxidant enzymes and phase Ⅱ detoxifying enzymes which aimed at the detoxifica-tion and elimination of harmful exogenous chemicals, resulting in the facilitation of hepatoprotection. Oxidative stress is the com-mon pathogenesis of many liver diseases, while the Nrf2-ARE signaling pathway is extremely important in the prevention and progression of many liver diseases. Nrf2 has more recently been implicated as a new therapeutic target in treating liver diseases. Here, we focus on the most common liver diseases and the devel-opment of these conditions where activation of Nrf2 may alleviate disease progression, so as to provide reference for related re-search in the future.