OBJECTIVE To analyze the non-genetic risk factors for severe cutaneous adverse reactions （SCARs） related to antiepileptic drugs （AEDs） in HLA-B*15：02 negative patients， and provide a basis for clinical precision medication. METHODS A retrospective case-control design was used to include patients who underwent HLA-B*15：02 testing at our hospital from January 2022 to December 2024. Patients were divided into SCARs group （15 cases who were HLA-B*15：02 negative and diagnosed with SCARs） and control group （38 cases who were HLA-B*15：02 negative and used AEDs）. Risk factors were evaluated using univariate analysis and a multivariable Firth penalty likelihood logistic regression model （Firth regression）， and Benjamin-Hochberg false discovery rate （FDR） and Firth regression were used for correction， and sensitivity analysis was used to quantify the impact of potential biases in carbamazepine exposure rates in the control group on the results. RESULTS Univariate analysis showed that age≥50 years， use of carbamazepine， and combination use of antibiotics/antiviral drugs were risk factors for developing AEDs- related SCARs （OR＝18.15， 7.54， 13.46， 95%CI of 4.13-79.84， 1.89-30.08， 1.36-133.18， all P＜0.05）， while taking lamotrigine was a protective factor [OR＝0.10， 95%CI of 0.02-0.39， P＜0.05]. After FDR correction， the above factors still maintained statistical significance （P＜0.05）. The results of multivariate analysis showed that age≥50 years [adjusted OR＝16.27， 95%CI of 3.98-66.55， P＜0.001] and taking carbamazepine [adjusted OR＝7.11， 95%CI of 1.82-27.85， P＝0.005] were independent risk factors for the occurrence of SCARs-related AEDs. The results of sensitivity analysis showed that the adjusted risk OR range for taking carbamazepine was between 14.2 and 28.4. CONCLUSIONS Age≥50 years and use of carbamazepine are independent non- genetic risk factors for the development of SCARs-related AEDs in HLA-B*15：02 negative patients. It is recommended that elderly patients should prioritize the use of AEDs other than carbamazepine.

Familial glucocorticoid deficiency type 4(FGD4) is a rare autosomal recessive disorder caused by mutations in the nicotinamide nucleotide transhydrogenase(NNT) gene. The article presented clinical data, laboratory results, and genetic mutation findings of a child with FGD4. Additionally, a retrospective analysis of the clinical data of FGD4 patients reported domestically and internationally was conducted, summarizing the types of gene mutations and clinical characteristics. This case identifies novel mutation sites in the NNT gene, providing a basis for the early diagnosis and treatment of FGD4 patients.

Objective:To systematically integrate qualitative researches on the financial toxicity experience of cancer patients, so as to provide reference for formulating intervention strategies for financial toxicity in cancer patients.Methods:Qualitative studies on financial toxicity experience of cancer patients were searched in Web of Science, PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, VIP, Wanfang data, and China Biology Medicine disc, with a search period from database establishment to August 31, 2023. The quality of the included literature was evaluated using the quality evaluation criteria for qualitative research of the Joanna Briggs Institute Evidence Based Health Care Center in Australia. The aggregation integration method was used to integrate the results.Results:A total of 12 articles were included, and 68 research results were extracted and categorized into 15 new categories. Four integrated results were obtained, including anxiety and stress under financial difficulties, relying on family members to start a new in adversity, and dancing together with treatment and life to write a new article, and great expectations for the future.Conclusions:Pay attention to the financial toxicity of cancer patients, actively seek response strategies, and bring benefits to cancer patients.

Objective:To investigate the predictive value of tumor regression rate after induction chemotherapy for survival of patients with locally advanced nasopharyngeal carcinoma.Methods:A total of 161 patients with stage Ⅲ-ⅣA nasopharyngeal carcinoma newly diagnosed at the Daping Hospital of Army Medical University from January 2009 to December 2012 were selected as the research subjects. The relationships between tumor size changes before and after induction chemotherapy and survival time were analyzed. Kaplan-Meier method was used to draw the survival curve accompanied with log-rank test. Cox regression analysis was used to analyze the risk factors affecting the prognosis of patients with nasopharyngeal carcinoma.Results:There were statistically significant differences in the tumor regression rate of primary lesions between N 1and N 2-3( Z=2.177, P=0.029), T 1-2and T 3-4( Z=-4.501, P<0.001)patients after induction chemotherapy. In N 1stage patients, the 5-year overall survival (OS) rates of patients with primary lesions achieving objective response ( n=18) and those without objective response ( n=19) after induction chemotherapy were 88.89% and 57.45%, and patients with cervical lymph node metastatic lesions achieving objective response ( n=19) and those without objective response ( n=18) were 86.72% and 49.10% respectively, with statistically significant differences ( χ2=6.023, P=0.014; χ2=7.441, P=0.006). In N 2-3stage patients, the 5-year OS rates of patients with primary lesions achieving objective response ( n=81) and those without objective response ( n=43) after induction chemotherapy were 77.56% and 50.70%, and patients with cervical lymph node metastatic lesions achieving objective response ( n=85) and those without objective response ( n=39) were 75.11% and 52.04% respectively, with significant differences ( χ2=8.037, P=0.005; χ2=7.268, P=0.007). Univariate Cox regression analysis showed that in patients with stage N 1, the tumor regression rate of primary lesions ( HR=0.048, 95% CI: 0.004-0.644, P=0.022), the efficacy of primary lesions ( HR=0.174, 95% CI: 0.037-0.830, P=0.028), the efficacy of cervical lymph node metastatic lesions ( HR=0.154, 95% CI: 0.033-0.725, P=0.017) after induction chemotherapy were significantly associated with OS; in N 2-3stage patients, the tumor regression rate of primary lesions ( HR=0.178, 95% CI: 0.056-0.564, P=0.003), the tumor regression rate of cervical lymph node metastatic lesions ( HR=0.081, 95% CI: 0.020-0.324, P<0.001), the efficacy of primary lesions ( HR=0.422, 95% CI: 0.228-0.781, P=0.006), the efficacy of cervical lymph node metastatic lesions ( HR=0.439, 95% CI: 0.238-0.813, P=0.009) after induction chemotherapy were significantly associated with OS. In multivariate Cox regression including N stage and tumor regression rate, N stage and efficacy, the interaction items were not statistically significant (all P>0.05). In T 1-2stage patients, the 5-year OS rates of patients with primary lesions achieving objective response ( n=45) and those without objective response ( n=13) after induction chemotherapy were 77.55% and 84.62%, and patients with cervical lymph node metastatic lesions achieving objective response ( n=43) and those without objective response ( n=15) were 78.89% and 80.00% respectively, with no significant differences ( χ2=0.239, P=0.625; χ2=0.005, P=0.943); in T 3-4stage patients, the 5-year OS rates of patients with primary lesions achieving objective response ( n=54) and those without objective response ( n=49) after induction chemotherapy were 78.90% and 45.00%, and patients with cervical lymph node metastatic lesions achieving objective response ( n=61) and those without objective response ( n=42) were 75.10% and 42.89% respectively, with significant differences ( χ2=13.615, P<0.001; χ2=12.752, P<0.001). Univariate Cox regression analysis showed that in patients with stage T 1-2, the tumor regression rate, the efficacy of primary lesions and cervical lymph node metastatic lesions after induction chemotherapy were not related to OS (all P>0.05); in T 3-4stage patients, the tumor regression rate of primary lesions ( HR=0.121, 95% CI: 0.033-0.444, P=0.001), the tumor regression rate of cervical lymph node metastatic lesions ( HR=0.126, 95% CI: 0.036-0.442, P=0.001), the efficacy of primary lesions ( HR=0.297, 95% CI: 0.150-0.588, P<0.001), the efficacy of cervical lymph node metastatic lesions ( HR=0.329, 95% CI: 0.173-0.625, P=0.001) after induction chemotherapy were significantly associated with OS. Multivariate Cox regression analysis showed that the interaction test of T stage and the efficacy of primary lesion trended to be statistically significant ( P=0.062). Conclusion:In patients with stage Ⅲ-ⅣA nasopharyngeal carcinoma, the responsiveness to induction chemotherapy in stage T 3-4patients has important value in predicting survival prognosis.

Objective:To explore the clinical characteristics and etiology of children with alimentary tract hemorrhage so as to optimize the diagnosis and treatment.Methods:The clinical data of 2 054 children with alimentary tract hemorrhage in Kunming Children′s Hospital from January 2014 to December 2018 were retrospectively analyzed.Results:Among 2 054 children with alimentary tract hemorrhage, males was in 1 274 cases, females was in 780 cases, and the ratio of males to females was 1.6∶1; <3.0 years old was in 647 cases (31.5%), 3.0 to 5.9 years old was in 488 cases (23.8%), 6.0 to 8.9 years old was in 413 cases (20.1%), 9.0 to 11.9 years old was in 281 cases (13.7%), and ≥12 years old was in 225 cases (11.0%); upper alimentary tract hemorrhage was in 991 cases, lower alimentary tract hemorrhage was in 1063 cases. The top three causes of children with upper alimentary tract hemorrhage were acute or chronic gastritis/ gastric ulcer, anaphylactoid purpura and systemic serious infection; the top three causes of children with lower alimentary tract hemorrhage were intestinal polyps, anaphylactoid purpura and food protein allergic colitis. A rare causes of alimentary tract hemorrhage had Peutz-Jeghers syndrome, cavernous transformation of portal vein, Bartter syndrome, systemic lupus erythematosus, Budd-Chiari syndrome, annular pancreas, Reye syndrome, Klippel-Trenaunay syndrome, Evans syndrome and perianal angiectasia and so on.Conclusions:Alimentary tract hemorrhage is a common disease in pediatrics. With the increase of age, the proportion of children with alimentary tract hemorrhage decreased. The main causes of upper and lower alimentary tract hemorrhage are different in different age stages. In addition to paying attention to common causes, the rare causes of alimentary tract hemorrhage should be vigilant and recognized.

Objective:To explore the needs for discharge plans in patients with ischemic stroke and their family members, and provide a reference for formulating a scientific and standardized discharge plan.Methods:Totally 15 patients with hemiplegia after ischemic stroke admitted in our hospital between January and March 2019 and 15 family members received semi-structured in-depth interviews using phenomenological research methods in qualitative studies. Colaizzi analysis was used to encode, analyze, categorize and refine the data.Results:The needs for discharge plans in patients with hemiplegia after ischemic stroke were summarized into 5 themes, namely, disease knowledge, rehabilitation exercise, psychological support, financial support, and referral services; the needs for discharge plans in family members were summarized into 3 themes, namely, care knowledge/skills guidance, rehabilitation equipment guidance and respite care needs.Conclusions:Patients with hemiplegia after ischemic stroke and their family members have high needs for discharge plans. A personalized multidisciplinary collaborative discharge plan should be provided, and the role of communities in the follow-up rehabilitation treatment should be given full play to.

Coronavirus disease 2019 (COVID-19) outbroke in Wuhan, China in December 2019 and the severe acute respiratory syndrome (SARS) outbroke in Guangzhou, China in 2003 were caused by highly pathogenic coronaviruses with high homology. Since the 2019 novel coronavirus is highly contagious and spreads rapidly. It has caused negative social effects and massive economic loss globaly. Currently there is no vaccine or effective drugs. Pulmonary fibrosis is a pulmonary disease with progressive fibrosis, which is the main factor leading to pulmonary dysfunction and declined quality of life in SARS survivors after recovery. Extensive epidemiological, viral immunological and current clinical evidences support the possibility that pulmonary fibrosis may be one of the major complications in COVID-19 patients. At present there is no report on the mechanism by which COVID-19 induces pulmonary fibrosis.With the existing theoretical basis, this article focuses on discussing the possible mechanism of COVID-19 sustained lung damaging, the key role of abnormal immune mechanism in the initiation and promotion of pulmonary fibrosis, and the corresponding therapeutic measures.

Objective? To explore the status quo of creative self-efficacy and research performance in nursing undergraduates and to analyze the correlation between the two. Methods? Totally 190 senior nursing undergraduates who practiced in the Second Affiliated Hospital of Kunming Medical University were selected by convenient sampling and investigated with the Creative Self-Efficacy Scale and the Research Performance Self-Rating Scale for nursing staff. Results? The 190 nursing undergraduates' creative self-efficacy score totaled (65.31±9.51), and their total research performance score was (72.85±13.97). Univariate analysis revealed that there was statistically significant difference in creative self-efficacy scores between nursing undergraduates who were student leaders or not (P＜0.05); and there were statistically significant differences in research performance scores between nursing undergraduates with different English levels, computer skills and home address (P＜0.05). The scores of various dimensions creative self-efficacy were positively correlated with the scores of various dimensions of research performance (P＜ 0.01). Conclusions? Nursing undergraduates＇ creative self-efficacy and research performance need to be improved. Universities and colleges should actively launch activities which are beneficial to their research literacy and creative awareness and take scientific research activities as one of the most pathways to develop nursing students＇ research literacy and creativeness and entrepreneurship.

Objective To investigate the effect of cardiopulmonary bypass (CPB)on platelet inhibition rate(INHAA) and Aspirin resistance (AR) after coronary artery bypass grafting (CABG)surgery.Methods A total of 114 patients undergoing CABG surgery were divided into two groups:on-pump group(n=54)and off-pump group(n=60).Aspirin treatment(100 mg/d)was paused 7 days before surgery and continued 6 hours after surgery.INHAA was detected and calculated by using thrombelastography(TEG)at 6 hours after taking the last dose of aspirin before surgery(T0),12 hours (T1),5 days(T2),10 days (T3) and 15 days (T4) after surgery respectively.The incidence of AR was calculated.Results There was no significant difference in the overall INHAA between the two groups of on vs.off-pump(F =0.336,P =0.563),while the differences of INHAA index at each time point was statistically significant between two groups of on vs.off-pump(F =95.519,P =0.000).There was an interaction effect of timing and grouping(F =15.500,P =0.000).In comparison of INHAA between the two groups of on vs.off-pump at each time point,INHAA was higher in on-pump group than in off-pump group at T1 (P＜0.05),while INHAAbecame lower in on-pump group than in off-pump group at T2 (P＜0.05),and there was no statistical difference in INHAAbetween the two groups at T3 and T4 (P ＞0.05).In the on-pump group,the total difference of INHAA at different time points was significant (P＜0.05),and the INHAA was lower at T2 than at T1,T3,T4 (P＜0.05).In the off-pump group,the total difference of INHAA between different time points was significant(P＜0.05),and the INHAA was lower at T1 than at T2,T3,T4 (P＜0.05).In comparison of AR incidence after CABG surgery between two groups of on vs.off-pump at each time point,the incidence of AR was lower in on-pump group than in off-pump group at T1 (P ＜ 0.05),while there were no statistical significance between two groups of on vs.off-pump at T2,T3 and T4 (P＞0.05).In comparison of AR incidence after CABG surgery between two groups of on vs.off-pump at each time point,the incidence of AR was lower in on-pump group than in off-pump group at T1 (P ＜0.05),while there were no statistical significance between two groups of on vs.off-pump at T2,T3 and T4 (P ＞ 0.05).Conclusions The increase of platelet inhibition rate and aspirin resistance occurs in early period after CABG surgery.The platelet inhibition rate is higher and aspirin resistance rate is lower in on-pump group than in off-pump group at 12 h after surgery,and the platelet inhibition rate is lower at 5 days after CABG surgery in on-pump group than in off-pump group.CPB has little effect on the platelet inhibition rate and on the incidence of AR after 5 days of CABG surgery.

Remote monitoring has changed the traditional management chronic heart failure patients, and nurses can implement continuous care for patients more efficiently. This article reviews the concept of remote monitoring, the application and effects of remote monitoring, the role of nurses in remote monitoring of chronic heart failure, the application and supervision of remote monitoring, and the establishment of a personalized integrated management network platform for patients with chronic heart failure.