Objective To systematically evaluate the impact of cough enhancement techniques on weaning outcomes in adult patients under mechanical ventilation(MV).Methods Databases from the inception to 15th November,2024 were searched for randomised controlled trials(RCTs)on cough enhancement technique in MV patients.The searched databases were CNKI,Wanfang Data base,SinoMed,Vip,PubMed,Web of Science,Cochrane Library,Embase,and CINAHL.Literature and evidence quality were evaluated using Cochrane's evaluation tool for intervention research and the GRADE system,and data were extracted and analysed via Meta-analysis with Review Manager 5.3.Results A total of 27 studies were included,involving 2,322 patients(1,169 in the trial group and 1,153 in the control group).Compared with the control group,the trial group had shorter time of mechanical ventilation[MD=-1.40,95%CI(-1.83,-0.97),P<0.001],lower weaning failure rate[OR=0.48,95%CI(0.27,0.85),P=0.01],higher oxygenation index[MD=35.48,95%CI(21.53,49.43),P<0.001],lower pulmonary atelectasis incidence[OR=0.30,95%CI(0.18,0.49),P<0.001],greater sputum volume[MD=1.88,95%CI(0.76,3.01),P=0.001],shorter ICU stay[MD=-1.90,95%CI(-2.95,-0.85),P<0.001]and lower serum procalcitonin(PCT)[MD=-0.89,95%CI(-1.64,-0.14),P=0.02],all with statistically significant differences.However,there was no significant difference in the ventilator-associated pneumonia(VAP)between the two groups[OR=0.54,95%CI(0.21,1.35),P=0.19].Conclusion Cough enhancement techniques promote sputum discharge,improve infection and oxygenation,shorten mechanical ventilation and ICU stay,reduce weaning failure and atelectasis rates in MV patients.Further studies are required to reduce the incidence of VAP.

Objective To investigate the prevalence of Schistosoma japonicum infections in wild rodents in schistosomiasis-endemic areas of China, so as to provide insights into formulation of technical guidelines for monitoring of and the precise control strategy for S. japonicum infections in wild rodents during the elimination phase. Methods Two administrative villages where schistosomiasis was historically highly prevalent were selected each from Dongzhi County, Anhui Province, and Duchang County, Jiangxi Province as study villages. Wild rodents were captured from study villages with baited traps or cages at night in June and September, 2021. The number of rodents captured was recorded, and the rodent species was characterized based on morphologi-cal characteristics. Liver tissues were sampled from captured rodents for macroscopical observation of the presence of egg granu- lomas, and S. japonicum infection was detected simultaneously using liver tissue homogenate microscopy, examinations of mesenteric tissues for parasites, and modified Kato-Katz thick smear technique (Kato-Katz technique). A positive S. japonicum infection was defined as detection of S. japonicum eggs or adult worms by any of these methods. The rate of wild rodent capture and prevalence of S. japonicum infections in wild rodents were compared in different study villages and at different time periods, and the detection of S. japonicum infections in wild rodents was compared by different assays. Results The overall rate of wild ro- dent capture was 8.28% (237/2 861) in Dongzhi County, and the wild rodent capture rates were 9.24% (133/1 439) and 7.31% (104/1 422) in two study villages (χ² = 3.503, P = 0.061), and were 8.59% (121/1 409) and 7.99% (116/1 452) in June and September, 2021, respectively (χ² = 0.337, P = 0.561). The overall rate of wild rodent capture was 3.72% (77/2 072) in Duchang County, and the wild rodent capture rates were 6.91% (67/970) and 0.91% (10/1 102) in two study villages (χ² = 51.901, P < 0.001), and were 4.13% (39/945) and 3.37% (38/1 127) in June and September, 2021, respectively (χ² = 0.815, P = 0.365). Rattus norvegicus was the predominant rodent species captured in both counties, accounting for 70.04% (166/237) of all captured wild rodents in Dongzhi County and 88.31% (68/77) in Duchang County. No S. japonicum infection was detected in wild rodents captured in Duchang County. Nevertheless, the overall prevalence of S. japonicum infections was 51.05% (121/237) in wild rodents captured in Dongzhi County, with prevalence rates of 50.38% (67/133) and 51.92% (54/104) in two study villages (χ² = 0.098, P = 0.755), and 54.31% (63/116) and 47.93% (58/121) in September and June, 2021, respectively (χ² = 0.964, P = 0.326). Of 237 wild rodents captured in Dongzhi County, there were 140 (59.07%) rodents with visible hepatic egg granulomas, 117 (49.47%) tested positive for S. japonicum eggs by liver tissue homogenate microscopy, 34 (14.35%) tested positive for S. japonicum eggs with Kato-Katz technique; however, no adult S. japonicum worms were detected in mesenteric tissues. In addition, hepatic egg granulomas were found in all wild rodents tested positive for S. japonicum eggs with liver tissue homogenate microscopy. Conclusions The rate of wild rodent capture and prevalence of S. japonicum infection in wild rodents vary greatly in schistosomiasis-endemic areas of China, and the prevalence of S. japonicum infection is slightly higher in wild rodents captured in autumn than in summer. Liver tissue is recommended as the preferred sample for surveillance of S. japonicum infection in wild rodents, and a combination of macroscopical observation of hepatic egg granulomas and liver tissue homogenate microscopy may be a standard method for surveillance of S. japonicum infection in wild rodents.

Objective To systematically evaluate the impact of cough enhancement techniques on weaning outcomes in adult patients under mechanical ventilation(MV).Methods Databases from the inception to 15th November,2024 were searched for randomised controlled trials(RCTs)on cough enhancement technique in MV patients.The searched databases were CNKI,Wanfang Data base,SinoMed,Vip,PubMed,Web of Science,Cochrane Library,Embase,and CINAHL.Literature and evidence quality were evaluated using Cochrane's evaluation tool for intervention research and the GRADE system,and data were extracted and analysed via Meta-analysis with Review Manager 5.3.Results A total of 27 studies were included,involving 2,322 patients(1,169 in the trial group and 1,153 in the control group).Compared with the control group,the trial group had shorter time of mechanical ventilation[MD=-1.40,95%CI(-1.83,-0.97),P<0.001],lower weaning failure rate[OR=0.48,95%CI(0.27,0.85),P=0.01],higher oxygenation index[MD=35.48,95%CI(21.53,49.43),P<0.001],lower pulmonary atelectasis incidence[OR=0.30,95%CI(0.18,0.49),P<0.001],greater sputum volume[MD=1.88,95%CI(0.76,3.01),P=0.001],shorter ICU stay[MD=-1.90,95%CI(-2.95,-0.85),P<0.001]and lower serum procalcitonin(PCT)[MD=-0.89,95%CI(-1.64,-0.14),P=0.02],all with statistically significant differences.However,there was no significant difference in the ventilator-associated pneumonia(VAP)between the two groups[OR=0.54,95%CI(0.21,1.35),P=0.19].Conclusion Cough enhancement techniques promote sputum discharge,improve infection and oxygenation,shorten mechanical ventilation and ICU stay,reduce weaning failure and atelectasis rates in MV patients.Further studies are required to reduce the incidence of VAP.

Objective To systematically review the incidence and influencing factors of refeeding syndrome(RFS)in critically ill patients,and provide references for early identification of RFS and formulation of preventive measures.Methods Computerized searches were conducted for studies on RFS in critically ill patients in the databases of China National Knowledge Infrastructure(CNKI),Wanfang,VIP,CBM,PubMed,Embase,Web of Science,CINAHL,Cochrane Library from inception to May 29th,2024.Data analysis was performed using Stata 16.0 software.Results A total of 29 articles with 5 720 participants were included.The Meta-analysis showed that the incidence of RFS in critically ill patients was 33.68％.The subgroup analysis showed that the incidence of RFS in critically ill patients was higher in studies conducted in 2020 or later(38.22％),in the Americas(36.39％),and with only electrolyte changes as the diagnostic basis(37.51％).Risk factors for RFS in critically ill patients included higher acute physiological and chronic health evaluation Ⅱ scores(OR=1.41),higher sequential organ failure assessment scores(OR=1.29),initiation of feeding within 48 h of ICU admission(OR=3.36),age ≥60 years(OR＝2.82),diabetes mellitus(OR=3.53),pre-albumin concentration＜150 g/L(OR=5.53),albumin concentration＜30 g/L(OR=3.26),caloric intake＞25％standard calories(OR=2.86),enteral solution temperature of 36～38 ℃(OR=2.32),feeding rate＞50 ml/h(OR=3.76),fasting time ≥2 d before feeding(OR=2.46),history of alcoholism(OR=2.64).Conclusion The incidence of RFS in critically ill patients is high and there are many influencing factors.Nurses should improve their awareness and attention to RFS,accurately identify high-risk groups and risk factors,and adopt a multidisciplinary collaborative model to develop whole-course,detailed and personalized intervention measures to prevent RFS.

Objective:To investigate the clinical features and prognosis of testicular relapse in pediatric acute lymphoblastic leukemia (ALL).Methods:Clinical data including the age, time from initial diagnosis to recurrence, relapse site, and therapeutic effect of 37 pediatric ALL with testicular relapse and treated in Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences between November 2011 and December 2022 were analyzed retrospectively. Patients were grouped according to different clinical data. Kaplan-Meier analysis was used to evaluate the overall survival (OS) rate and event free survival (EFS) rate for univariate analysis, and Cox proportional-hazards regression model was used to evaluate the influencing factors of OS rate and EFS rate for multivariate analysis.Results:The age at initial diagnosis of 37 pediatric testicular relapse patients was (5±3) years and the time from initial diagnosis to testicular recurrence was (37±15) months. The follow-up time was 43 (22, 56) months. Twenty-three patients (62%) were isolated testis relapse. The 5-year OS rate and EFS rate of the 37 relapsed children were (60±9) % and (50±9) % respectively. Univariate analysis showed that the 2-year EFS rate in the group of patients with time from initial diagnosis to testicular recurrence >28 months was significantly higher than those ≤28 months ((69±10)% vs. (11±11)%, P<0.05), 2-year EFS rate of the isolated testicular relapse group was significantly higher than combined relapse group ((66±11)% vs. (20±13) %, P<0.05), 2-year EFS rate of chimeric antigen receptor T (CAR-T) cell treatment after relapse group was significantly higher than without CAR-T cell treatment after relapse group ((78±10)% vs. (15±10)%, P<0.05). ETV6-RUNX1 was the most common genetic aberration in testicular relapsed ALL (38%, 14/37). The 4-year OS and EFS rate of patients with ETV6-RUNX1 positive were (80±13) % and (64±15) %, respectively. Multivariate analysis identified relapse occurred≤28 months after first diagnosis ( HR=3.09, 95% CI 1.10-8.72), combined relapse ( HR=4.26, 95% CI 1.34-13.52) and CAR-T cell therapy after relapse ( HR=0.15,95% CI 0.05-0.51) were independent prognostic factors for 2-year EFS rate (all P<0.05). Conclusions:The outcome of testicular relapse in pediatric ALL was poor. They mainly occurred 3 years after initial diagnosis. ETV6-RUNX1 is the most common abnormal gene.Patients with ETV6-RUNX1 positive often have a favorable outcome. Early relapse and combined relapse indicate unfavorable prognosis, while CAR-T cell therapy could significantly improve the survival rate of children with testicular recurrence.

Objective:To investigate the clinical characteristics and long-term prognostic factors of relapsed pediatric acute lymphoblastic leukemia (ALL).Methods:Clinical data including the age, time from initial diagnosis to relapse, relapse site, and molecular biological features of 217 relapsed ALL children primarily treated by the Chinese Children's Leukemia Group (CCLG)-ALL 2008 protocol in Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences between April 2008 and April 2015 were collected and analyzed in this retrospective cohort study. Kaplan-Meier analysis was used to evaluate the overall survival (OS) rate and event free survival (EFS) rate for univariate analysis, and Cox proportional-hazards regression model was used to evaluate the influencing factors of OS rate and EFS rate for multivariate analysis.Results:The age at initial diagnosis of 217 relapsed patients was 5 (3, 7) years. There were 135 males and 82 females. The time from initial diagnosis to relapse of 217 children was 22 (10, 39) months. After relapse, 136 out of 217 children (62.7%) received treatment and the follow-up time was 65 (47, 90) months. The 5-year OS rate and EFS rate of the 136 relapsed children were (37±4) % and (26±4) %, respectively. The predicted 10-year OS rate and EFS rate were (35±5) % and (20±4) %, respectively. Univariate analysis showed that the 5-year OS rate in the group of patients with late relapse (43 cases) was significantly higher than those with very early (54 cases) and early relapse (39 cases) ((72±7)% vs. (16±5)%, (28±8)%, χ2=35.91, P<0.05), 5-year OS rate of the isolated extramedullary relapse group (20 cases) was significantly higher than isolated bone marrow relapse group (102 cases) and combined relapse group (14 cases) ((69±11)% vs. (31±5)%, (29±12)%, χ2=9.14, P<0.05), 5-year OS rate of high-risk group (80 cases) was significantly lower than standard-risk group (10 cases) and intermediate-risk group (46 cases) ((20±5)% vs. (90±10)%, (54±8)%, χ2=32.88, P<0.05). ETV6::RUNX1 was the most common fusion gene (13.2%, 18/136). The predicted 10-year OS rate of relapsed children with positive ETV6::RUNX1 was significantly higher than those without ETV6::RUNX1 (118 cases) ((83±9)% vs. (26±5)%, χ2=14.04, P<0.05). The 5-year OS for those accepted hematopoietic stem cell transplantation (HSCT) after relapse (42 cases) was higher than those without HSCT (94 cases) ((56±8)% vs. (27±5)%, χ2=15.18, P<0.05). Multivariate analysis identified very early/early relapse ( HR=3.91, 95% CI 1.96-7.79; HR=4.15, 95% CI 1.99-8.67), bone marrow relapse including isolated bone marrow relapse and combined relapse ( HR=6.50, 95% CI 2.58-16.34; HR=5.19, 95% CI 1.78-15.16), with ETV6::RUNX1 ( HR=0.23, 95% CI 0.07-0.74) and HSCT after relapse ( HR=0.24, 95% CI 0.14-0.43) as independent prognostic factors for OS (all P<0.05). Conclusions:Relapsed pediatric ALL mainly occurs very early and often affects bone marrow, which confer poor outcome. ETV6::RUNX1 is the most common genetic aberration with a favorable outcome. HSCT could rescue the outcome of relapsed children, though the survival rate is still poor.

Objective To develop and validate a prediction model for extended hospitalisation in patients with ischemic stroke.Methods A total of 318 patients with ischemic stroke hospitalised between November 2021 and May 2023 in a Grade ⅢA hospital in Changzhou were selected as study objects with a convenience sampling method.The modelling group consisted 212 patients and the validation group included 106 patients.The patients in the modelling group were divided into a group of extended hospital stay and a group of normal hospital stay.Binary logistic regression analysis was conducted to develop the prediction model,and data from the 106 patients in the validation group were then incorporated into the developed prediction model.The prediction performance and goodness-of-fit of the model were accessed using the area under the curve(AUC)of the receiver operation characteristic(ROC)curve and the Hosmer-Lemeshow test.Results Multivariate logistic analysis showed that comorbid diabetes,number of complications during hospitalisation,a Braden score less than 18,and a white blood cell count greater than 3.5×109/L or more than 9.5×109/L were the risk factors of extended hospitalisation in patients with cerebral ischemic stroke.Based on the factors,a prediction model was developed with following formula:P=1/[1+exp(-Z)].Hosmer-Lemeshow test for the prediction model yielded χ 2=7.430,P=0.191.AUC of the prediction model was 0.818(95％CI:0.754-0.883,P<0.001)with Jordon index of 0.51 and the optimal cut-off value of 0.268,sensitivity of 78.9％and specificity of 72.3％The results of the validation of independent data model showed a sensitivity of 75.0％,specificity of 74.4％,and accuracy of 74.5％.Conclusion Comorbid diabetes,Braden score at admission,white blood cell count and the number of complications during hospitalisation are the significant factors that affect the length of hospital stay in the patients with ischemic stroke.The prediction model for extended hospitalisation of the patients with ischemic stroke exhibits good predictive value and can provide reference in clinical decision-making.

Objective To retrieve,evaluate and summarise evidence on home exercise rehabilitation in patients with stage Ⅱ coronary heart disease(CHD)undergoing cardiac rehabilitation and to provide a reference for healthcare professionals to instruct the patients for home-based exercise rehabilitation.Methods Following the"6S"evidence hierarchy model and a top-down search strategy,a systematic search was conducted across databases of Guidelines International Network(GIN),Scottish Intercollegiate Guidelines Network(SIGN),National Institute for Health and Clinical Excellence(NICE),American Association of Cardiovascular and Pulmonary Rehabilitation(AACVPR),American Heart Association(AHA),European Society of Cardiology(ESC),BMJ Best Practice,UpToDate,Joanna Briggs Institute(JBI)evidence-based healthcare database,PubMed,Web of Science,Cochrane Library,EBSCON,SinoMed,China National Knowledge Infrastructure(CNKI),and Wanfang Data Knowledge Service Platform for guidelines,expert consensus,evidence summaries,systematic reviews,primary study and clinical decisions regarding home-based exercise rehabilitation for patient with CHD phase Ⅱ cardiac rehabilitation.Literature included the articles published on databases from the inception to December 2023.Two researchers independently evaluated the quality of acquired literature and the extracted and integrated the evidence.Results A total of 15 articles were retrieved,including 5 guidelines,3 expert consensuses,2 evidence summaries,3 systematic reviews and 2 clinical decisions.A total of 23 best evidence statements were summarised and further reduced to 5 topics:exercise benefits,exercise assessment,exercise prescription,safety and monitoring,and health education.Conclusion This study summarises the best evidence for home-based exercise rehabilitation in patients with phase Ⅱ cardiac rehabilitation.It recommends that healthcare professionals should consider the clinical context rehabilitation,by taking into account of the needs and preferences of patients and their families,when applying the evidence and developing appropriate and individualised plans for exercise hence to promote the recovery of patients.

Objective To develop and validate a prediction model for extended hospitalisation in patients with ischemic stroke.Methods A total of 318 patients with ischemic stroke hospitalised between November 2021 and May 2023 in a Grade ⅢA hospital in Changzhou were selected as study objects with a convenience sampling method.The modelling group consisted 212 patients and the validation group included 106 patients.The patients in the modelling group were divided into a group of extended hospital stay and a group of normal hospital stay.Binary logistic regression analysis was conducted to develop the prediction model,and data from the 106 patients in the validation group were then incorporated into the developed prediction model.The prediction performance and goodness-of-fit of the model were accessed using the area under the curve(AUC)of the receiver operation characteristic(ROC)curve and the Hosmer-Lemeshow test.Results Multivariate logistic analysis showed that comorbid diabetes,number of complications during hospitalisation,a Braden score less than 18,and a white blood cell count greater than 3.5×109/L or more than 9.5×109/L were the risk factors of extended hospitalisation in patients with cerebral ischemic stroke.Based on the factors,a prediction model was developed with following formula:P=1/[1+exp(-Z)].Hosmer-Lemeshow test for the prediction model yielded χ 2=7.430,P=0.191.AUC of the prediction model was 0.818(95％CI:0.754-0.883,P<0.001)with Jordon index of 0.51 and the optimal cut-off value of 0.268,sensitivity of 78.9％and specificity of 72.3％The results of the validation of independent data model showed a sensitivity of 75.0％,specificity of 74.4％,and accuracy of 74.5％.Conclusion Comorbid diabetes,Braden score at admission,white blood cell count and the number of complications during hospitalisation are the significant factors that affect the length of hospital stay in the patients with ischemic stroke.The prediction model for extended hospitalisation of the patients with ischemic stroke exhibits good predictive value and can provide reference in clinical decision-making.

Objective To retrieve,evaluate and summarise evidence on home exercise rehabilitation in patients with stage Ⅱ coronary heart disease(CHD)undergoing cardiac rehabilitation and to provide a reference for healthcare professionals to instruct the patients for home-based exercise rehabilitation.Methods Following the"6S"evidence hierarchy model and a top-down search strategy,a systematic search was conducted across databases of Guidelines International Network(GIN),Scottish Intercollegiate Guidelines Network(SIGN),National Institute for Health and Clinical Excellence(NICE),American Association of Cardiovascular and Pulmonary Rehabilitation(AACVPR),American Heart Association(AHA),European Society of Cardiology(ESC),BMJ Best Practice,UpToDate,Joanna Briggs Institute(JBI)evidence-based healthcare database,PubMed,Web of Science,Cochrane Library,EBSCON,SinoMed,China National Knowledge Infrastructure(CNKI),and Wanfang Data Knowledge Service Platform for guidelines,expert consensus,evidence summaries,systematic reviews,primary study and clinical decisions regarding home-based exercise rehabilitation for patient with CHD phase Ⅱ cardiac rehabilitation.Literature included the articles published on databases from the inception to December 2023.Two researchers independently evaluated the quality of acquired literature and the extracted and integrated the evidence.Results A total of 15 articles were retrieved,including 5 guidelines,3 expert consensuses,2 evidence summaries,3 systematic reviews and 2 clinical decisions.A total of 23 best evidence statements were summarised and further reduced to 5 topics:exercise benefits,exercise assessment,exercise prescription,safety and monitoring,and health education.Conclusion This study summarises the best evidence for home-based exercise rehabilitation in patients with phase Ⅱ cardiac rehabilitation.It recommends that healthcare professionals should consider the clinical context rehabilitation,by taking into account of the needs and preferences of patients and their families,when applying the evidence and developing appropriate and individualised plans for exercise hence to promote the recovery of patients.