Objective To explore the difference in clinical efficacy of sacubitril valsartan(SV)and enalapril in the treatment of elderly patients with chronic heart failure with reduced ejection frac-tion(HFrEF).Methods A total of 126 elderly patients with chronic HFrEF admitted in our de-partment between January 2020 and January 2023 were prospectively recruited and randomly di-vided into control group(enalapril treatment,63 cases)and observation group(SV treatment,63 cases).After 3 months of treatment,the improvement rate of NYHA cardiac function grade,and changes in cardiac function indicators[6-minute walking distance(6MWD),NT-proBNP,LVEDD,LVEF],and echocardiographic indicators[left ventricular myocardial work(Tei)index,stroke volume,cardiac output(CO)]before and after treatment,adverse reactions during treat-ment and prognosis were compared between the two groups.Results The improvement rate of NYHA grade was significantly higher in the observation group than the control group(80.95％vs 65.08％,P＜0.05).The results of 6MWD,LVEF,stroke volume and CO were obviously higher in both groups after treatment than before treatment(P＜0.05).The results of 6MWD,LVEF,stroke volume and CO were notably higher in the observation group than the control group(P＜0.01).The SBP,DBP,NT-proBNP,heart rate,LVEDD and LV Tei index were decreased after treatment in both groups,and those in the observation group were even lower than those in the control group(P＜0.05,P＜0.01).As of April 2024,the readmission rates due to HF was re-markably lower in the observation group than the control group(7.94％vs 20.63％,P＜0.05),but no statistical difference was seen in the mortality or the incidence of adverse reactions be-tween them(P＞0.05).Conclusion SV is superior to enalapril in improving the efficacy,cardiac function and cardiac load of elderly HFrEF patients,with advantages of reducing the incidence of readmission but not increasing adverse reactions.

Objective To explore the difference in clinical efficacy of sacubitril valsartan(SV)and enalapril in the treatment of elderly patients with chronic heart failure with reduced ejection frac-tion(HFrEF).Methods A total of 126 elderly patients with chronic HFrEF admitted in our de-partment between January 2020 and January 2023 were prospectively recruited and randomly di-vided into control group(enalapril treatment,63 cases)and observation group(SV treatment,63 cases).After 3 months of treatment,the improvement rate of NYHA cardiac function grade,and changes in cardiac function indicators[6-minute walking distance(6MWD),NT-proBNP,LVEDD,LVEF],and echocardiographic indicators[left ventricular myocardial work(Tei)index,stroke volume,cardiac output(CO)]before and after treatment,adverse reactions during treat-ment and prognosis were compared between the two groups.Results The improvement rate of NYHA grade was significantly higher in the observation group than the control group(80.95％vs 65.08％,P＜0.05).The results of 6MWD,LVEF,stroke volume and CO were obviously higher in both groups after treatment than before treatment(P＜0.05).The results of 6MWD,LVEF,stroke volume and CO were notably higher in the observation group than the control group(P＜0.01).The SBP,DBP,NT-proBNP,heart rate,LVEDD and LV Tei index were decreased after treatment in both groups,and those in the observation group were even lower than those in the control group(P＜0.05,P＜0.01).As of April 2024,the readmission rates due to HF was re-markably lower in the observation group than the control group(7.94％vs 20.63％,P＜0.05),but no statistical difference was seen in the mortality or the incidence of adverse reactions be-tween them(P＞0.05).Conclusion SV is superior to enalapril in improving the efficacy,cardiac function and cardiac load of elderly HFrEF patients,with advantages of reducing the incidence of readmission but not increasing adverse reactions.

Objective:To explore the effectiveness of the Shewhart control chart-based assessment and early warning system in prevention of medical device-related pressure injury(MDRPI).Methods:152 critically ill patients admitted to Hebei Central Hospital from January 2020 to December 2021 were selected and divided into a control group and an observation group based on different methods of assessing MDRPI risk,with 76 cases in each group.The control group adopted the Braden scale to assess the risk of MDRPI.The observation group adopted a safety early warning system based on Shewhart control charts to assess the risk of MDRPI in patients.Nursing measures were undertaken according to MDRPI risk grade in both groups.The occurrence of adverse events of MDRPI,nursing safety quality and nursing comprehensive quality were compared between the two groups.Results:The incidence rate of head,neck and face adverse events of MDRPI and the total incidence of adverse events of MDRPI of the patients in the observation group were lower than those in the control group(x2=4.802,5.758,P<0.05).The safety quality and comprehensive quality of nursing of 20 nurses in the observation group were higher than those in the control group(t=6.654,7.172,P<0.05).Conclusion:The application of assessment and early warning system based on Shewhart control chart in clinical nursing management can effectively reduce the incidence of MDRPI adverse events and improve the quality of nursing safety and comprehensive nursing.

Ancient traditional Chinese medical ethics thought is a value system with Pre-Qin Confucian benevolence thought as the core. Under the cultivation and regulations of Pre-Qin Confucian benevolence, such as "benevolent love", "taking life as morality" and "self-denial and ritual", ancient Chinese medicine gradually formed the medical ethics ideal of "helping the world and saving people", the medical ethics goal of "life is the most important" and emotion towards patient of "considering others in one’s own place". Learn from the past, cultivate the professional emotion of "saving people and helping the world" of medical staff through example education; using recessive education to guide both doctors and patients to respect their lives, thus creating a social atmosphere of mutual respect between doctors and patients, and advocating doctor-patient communication that apply oneself to others with the help of carrier education; the essence of ancient traditional Chinese medical ethics thought is integrated into the construction of contemporary medical ethics, so as to overcome the problem of medical ethics anomie that life is technicalized and medical services are materialized in today’s medical development, make contemporary medical ethics thought meet the needs of today’s medical development, make medical development return to benevolence and promote the healthy development of medicine.

Ischemic stroke is feature by high incidence,high disability and high mortality.Inflammation plays an important role in the occurrence and development of ischemic stroke.Activated microglia exhibit two different phenotypes of proinflammatory(M1)and anti-inflammatory(M2),and regulating the transformation of microglia from M1 to M2 is the key to clinical benefit.Recent studies have shown that autophagy plays a key role in regulating phenotypic transformation of microglia.How to exert the regulatory role of autophagy and promote the transformation of microglia into M2 type has become a hotspot of clinical research in reducing secondary brain injury after stroke.This paper reviews the research progress of autophagy regulation of microglia polarization in ischemic stroke,aim-ing to provide a reference for further clinical and basic research in this field.

The purpose of medical practice and attitude towards the remuneration of the ancient traditional Chinese medicine （TCM） practitioners have a high degree of commonality with Mozi’s concept of righteousness and benefit. Under the regulation of Mozi’s “ideology of valuing righteousness and advocating benefit”， ancient TCM practitioners formed the purpose of the medical practice of benefiting patients with skills and prioritizing righteousness， as well as the attitude towards the remuneration of balancing righteousness and benefit and gaining benefits from righteousness. Learning from the past to the present， the essence of TCM’s concept of righteousness and benefit was used to cultivate the pursuit of righteousness in medical practice among medical staff through infection education. Ideological and political education courses and media promotion were used to urge medical staff to keep the bottom line of medical practice of regulating benefit with righteousness. With the help of incentive mechanisms， various paths were constructed such as salary distribution that balanced righteousness and benefit incentive mechanisms， as well as organically integrated them into contemporary medical ethics education on the concept of righteousness and benefit， with a view to establishing a view of medical concept of righteousness and benefit that is in line with the current economic and social development， and to assist in building a harmonious doctor-patient relationship， promoting the medical health development， and building a human health community.

Objective To observe the clinical effect of remazolam combined with remifentanil on elderly patients undergoing painless fiberscopy,and to analyze its effect on the depth of sedation and hemodynamics.Methods Eighty-six elderly patients who underwent painless fiberscopy in Jiangxi Provincial Chest Hospital from January 2022 to June 2023 were selected as study subjects and divided into group A and group B according to the randomized lottery method.After enrollment,both groups of patients were opened to intravenous nasal catheter for oxygen administration,and 2% lidocaine was given to the patients,so that the patients held their breath for choking in order to fully diffuse into the trachea to achieve local anesthesia effect,and at the same time,remifentanil was given to the patients in both groups as the basic analgesia.On this basis,group A was injected with remazolam and group B was injected with propofol.The hemodynamic indexes[mean arterial pressure(MAP),pulse oximetry(SpO2)and heart rate(HR)]and Ramsay sedation scores of the two groups were recorded before anesthesia induction(T1),after anesthesia induction(T2),at the time of the passage of the fiberscope through the vocal folds(T3),at the time of the complete insertion of the fiberscope(T4),at the time of completing the examination(T5).And the onset time of sedation was compared between the two groups,awakening time,number of respiratory depression,adverse reactions and incidence,and satisfaction with the sedation effect in the two groups.Results The MAP and HR of group A were significantly lower than those of group B at T3,T4 and T5(P＜0.05).While the SPO2 and Ramsay sedation score were significantly higher than those of group B(P＜0.05).The repeated measures ANOVA and different awakening time measurements were statistically different between groups(P＜0.05).Compared with group B,group A had a significantly shorter sedation onset time and awakening time and fewer respiratory depression,which was statistically significant(P＜0.05).Group A had a statistically significant lower incidence rate of adverse reactions than group B(P＜0.05).Conclusion Remazolam combined with remifentanil in compound surface local anesthesia for painless ciliopathy has more efficient sedation effect,more stable hemodynamics,and lower incidence of adverse reactions for elderly patients,and it is a potential drug that can be a safer and more efficient.

Objective:To summarize the characteristics and nursing experience of patients of transthyretin amyloid polyneuropathy.Methods:A retrospective study was performed in 9 patients with transthyretin amyloid polyneuropathy from different area in china from February 2018 to October 2021 in the Second Affiliated Hospital Zhejiang University School of Medical, summarized nursing points:used list to popularize disease knowledge, improved the nursing skills of rare diseases; did a good job in the safety nursing of sensory motor disorders to prevent pressure sores, scalds, fall, thrombosis and other complications, paid attention to the nursing of autonomic nerve dysfunction, prevented postural hypotension. Observe and prevent heart failure, manage diarrhea and constipation, and applied the guide to personalized urinary tract management;provided genetic counseling services, personalized continuing care and psychological care.Results:During hospitalization, the clinical symptoms of 9 patients were improved to varying degrees, after 3 months of telephone follow-up after discharge, 9 patients had no adverse events such as pressure ulcer and fall.Conclusions:By improving specialized skills, predictive risk management and symptom care, the symptoms of postural hypotension, urinary retention, constipation, diarrhea and other symptoms of transthyretin amyloid polyneuropathy patients can be prevented and improved, and adverse events such as falls and pressure sores can be avoided.

Ancient traditional Chinese medical ethics thought is a value system with Pre-Qin Confucian benevolence thought as the core. Under the cultivation and regulations of Pre-Qin Confucian benevolence, such as "benevolent love", "taking life as morality" and "self-denial and ritual", ancient Chinese medicine gradually formed the medical ethics ideal of "helping the world and saving people", the medical ethics goal of "life is the most important" and emotion towards patient of "considering others in one’s own place". Learn from the past, cultivate the professional emotion of "saving people and helping the world" of medical staff through example education; using recessive education to guide both doctors and patients to respect their lives, thus creating a social atmosphere of mutual respect between doctors and patients, and advocating doctor-patient communication that apply oneself to others with the help of carrier education; the essence of ancient traditional Chinese medical ethics thought is integrated into the construction of contemporary medical ethics, so as to overcome the problem of medical ethics anomie that life is technicalized and medical services are materialized in today’s medical development, make contemporary medical ethics thought meet the needs of today’s medical development, make medical development return to benevolence and promote the healthy development of medicine.

Objective To explore the correlation between serum cystatin C,lipoprotein associated phospho-lipase A2 (LP-PLA2) and lower limb vascular disease in patients with type 2 diabetes mellitus.Methods From August 2014 to December 2016,a total of 187 type 2 diabetic patients in Weihai Central Hospital were selected. According to the ankle brachial index (ABI),the patients were divided into without lower limb vascular disease group (SDM group,85 cases) and with lower limb vascular disease group (T2DM+LLVD group,102 cases).Meanwhile,82 healthy people were selected as control group.The cystatin C,LP-PLA2,hemoglobin (HbAlc),triglyceride,total cholesterol,high density lipoprotein cholesterol ( HDL-C) and low density lipoprotein cholesterol ( LDL-C) were calculated.Results Compared with the control group [(0.788 ±0.084)mg/L],the cystatin C was significantly high-er in the SDM group[(0.913 ±0.135)mg/L] and the T2DM +LLVD group[(1.114 ±0.225)mg/L],and the difference was statistically significant (t＝5.511,9.121,all P＜0.01).The cystatin C in T2DM+LLVD group was higher than that in the SDM group ( t ＝7.209,P ＜0.01 ).Compared with the control group [( 342.76 ± 33.49)ng/mL],LP-PLA2 was significantly higher in the T2DM+LLVD group[(513.54 ±94.26)ng/mL],and the difference was statistically significant ( t ＝11.428,P＜0.01 ).Compared with the SDM group [( 352.28 ± 67.82)ng/mL],the cystatin C and LP-PLA2 levels were significantly higher that in the T2DM+LLVD group,and the difference was statistically significant (t＝7.209,13.181,all P＜0.01).Conclusion Cystatin C and LP-PLA2 play important roles in type 2 diabetic patients with lower limb vascular disease.Cystatin C and LP -PLA2 may become the forecast indicators in type 2 diabetic patients with lower limb vascular disease.