Objective To investigate the cause of a suspected outbreak of carbapenem-resistant Klebsiella pneumoniae infection(CRKP)in the neurological ICU,to find out the reason for infection and the way of transmission to provide evidence for the prevention and control of nosocomial infection.Methods Four patients with CRKP infection in the department of neurological ICU of a hospital from Au-gust 4 to August 20,2020 were investigated epidemiologically and environmental hygiene monitoring of the ward was carried out.Compre-hensive measures were taken to control the outbreak.Results All four CRKP infection cases were hospital-acquired,and the isolated strains showed consistent drug susceptibility test results,indicating they were the same clone.Environmental hygiene monitoring revealed the presence of the same clone in samples from patient bedside items,suction devices,oxygen therapy equipment,and personal belongings of healthcare workers.After implementing comprehensive corrective measures,no new cases of CRKP infection occurred,and subsequent surface sampling did not isolate any CRKP strains.Conclusion Environmental surface contamination in the neurointensive care unit and inadequate disinfection procedures were likely the main causes of the suspected outbreak of CRKP infection.Prompt identification of the outbreak,activation of emergency response plans,and implementation of corrective measures are crucial for controlling the outbreak of multidrug-resistant bacterial infections in hospitals.After adopting comprehensive measures,there were no new CRKP infection cases.

Objective To construct a predictive model for the severity of depression based on the expression of circular RNAs(circRNAs)in peripheral blood.Methods Selecting 80 patients with depression who visited our hospital from August 2022 to August 2023,they were divided into a mild to moderate group of 49 cases and a severe group of 31 cases.Forty healthy individuals were selected as the healthy group,and after gene chip screening,five circRNAs with significant differences were selected.Further analysis was conducted on the relationship between circRNAs and the severity of depression,and independent risk factors affecting the severity of depression were analyzed,based on the analysis results,construct a depression severity prediction model using a column chart based on the expression of circRNAs in peripheral blood.Results Compared with the healthy group and mild to moderate group,the severe group had circRNA_100679,circRNA_1 03636 relative expression level decreased,circRNA_102802,circRNA_103964,The relative expression level of circRNA_002143 increased(P＜0.05).CircRNA_100679,circRNA_103636 is negatively correlated with the severity of depression(r=-0.594,-0.512,P＜0.05),circRNA_102802,circRNA_103964,circRNA_002143 is positively correlated with the severity of depression(r=0.603,0.425,0.412,P＜0.05).CircRNA_100679,circRNA_102802,circRNA_103636,circRNA_103964,circRNA_002143,family history of mental illness,and 5-hydroxytryptamine(5-HT)are all risk factors for the severity of depression(P＜0.05).The predicted area under the curve of the column chart prediction model based on risk factors such as peripheral blood circRNAs is 0.900,with a 95％CI:0.811-0.945.The model has good discrimination and high internal validation consistency.Conclusion The construction of a column chart model based on circRNAs expression for predicting the severity of depression has good predictive value and can provide reference for the diagnosis and treatment of depression severity in clinical practice.

Objective:To investigate the predictive value of neutrophil/lymphocyte ratio (NLR) on the discharge outcome in elderly patients with acute ischemic stroke (AIS) receiving intravenous thrombolysis (IVT).Methods:Elderly patients with AIS received IVT in the Department of Neurology, the Second Affiliated Hospital of Soochow University from August 2018 to August 2020 were retrospectively included. The modified Rankin Scale was used to evaluate discharge outcome, and the score >2 was defined as poor outcome. Symptomatic intracranial hemorrhage (sICH) was defined as any intracranial hemorrhage found on imaging examination accompanied by neurological deterioration, where the National Institutes of Health Stroke Scale (NIHSS) score increased by ≥4 from baseline or bleeding led to death. Multivariate logistic regression analysis was used to determine independent risk factors for sICH and poor discharge outcome. Receiver operating characteristic (ROC) curves were used to analyze the predictive value of NLR for sICH and poor discharge outcome. Results:A total of 228 elderly patients with AIS receiving IVT were enrolled, including 118 males (51.8%), aged 73.64±8.16 years, with a baseline NIHSS score of 6.23±6.54. Ninety patients (39.5%) had poor outcome at discharge, and 16 (7.0%) developed sICH. Univariate analysis showed that the NLR in the poor outcome group was significantly higher than that in the good outcome group ( P<0.01). Multivariate logistic regression analysis showed that a higher NLR was an independent risk factor for poor discharge outcome (odds ratio [ OR] 1.245, 95% confidence interval [ CI] 1.044-1.484; P< 0.05) and sICH ( OR 1.124, 95% CI 1.010-1.251; P<0.05). ROC curve analysis showed that the area under the curve of NLR for predicting poor discharge outcome was 0.693 (95% CI 0.620-0.765; P<0.01). The optimal cutoff value was 4.345. Its corresponding sensitivity and specificity were 47.8% and 87.7%, respectively. The area under the curve of NLR for predicting sICH was 0.651 (95% CI 0.498-0.804; P<0.05). The optimal cutoff value was 3.515. Its corresponding sensitivity and specificity were 68.8% and 61.8%, respectively. Conclusions:A higher NLR is independently associated with sICH and poor discharge outcome in elderly patients with AIS receiving IVT, and have certain predictive value for sICH and poor discharge outcome.

Objective:To construction the early ambulation scheme for patients after laparoscopic colorectal cancer surgery.Methods:Based on evidence-based nursing method combined with clinical practice, the draft of early ambulation scheme for patients after laparoscopic colorectal cancer surgery was prepared. From August to October 2022, two rounds of correspondence were conducted with 15 experts by Delphi method, and the final draft of early ambulation scheme for patients after laparoscopic colorectal cancer surgery was formed.Results:The coefficient of expert positivity in the two rounds of correspondence was 100%, the coefficient of authority was respectively 0.86 and 0.87, and the Kendall cofficient of concordance was 0.241 and 0.167 ( P<0.001) . The final scheme consisted of preface and text. The text of the scheme contained 2 first-level items, 10 second-level items and 42 third-level items. Conclusions:The early ambulation scheme for patients after laparoscopic colorectal cancer surgery in this study is scientific and feasible, providing references for clinical medical staff to guide early getting out of bed activities for patients after laparoscopic colorectal cancer surgery.

Objective:To explore the application of nursing of theory education combined with experience education in the rehabilitation of patients with idiopathic pulmonary artery hypertension (IPAH) .Methods:Nursing of theory education combined with experience education was carried out in Department of Respiratory Medicine in Affiliated Hospital of Jining Medical University in December 2017. Using the convenient sampling method, 53 patients with IPAH who were admitted from August 2016 to December 2017 were selected as the control group and they were given routine nursing. A total of 53 IPAH patients who were admitted from January 2018 to May 2019 were selected as the research group, and they were given nursing of theory combined with experience education at basis of the control group. Before the intervention and 1 month after discharge from the hospital, patients in two groups were assesses by Exercise of Self-Care Agency (ESCA) scale, the MOS 36-item Short-Form Health Survey (SF-36) , 6 minutes walking distance (6MWD) and Borg Scale (BS) , and the occurrence of complications in the two groups during hospitalization and discharge for 1 month was recorded.Results:After 1 month of discharge, scores of self-care skills, self-care concept, self-care responsibilities and health knowledge and the total self-care score of ESCA were respectively (35.52±2.16) , (22.32±1.55) , (27.15±2.02) , (48.67±2.85) and (130.67±3.38) . Scores of physical functioning, role-physical, vitality, role-emotional, social functioning and mental health and overall health score of SF-36 were respectively (74.73±12.83) , (71.79±11.31) , (72.06±11.43) , (69.67±10.54) , (71.23±10.72) , (72.43±13.30) and (65.45±14.27) . The 6MWD distance was (512.67±86.85) m, and BS score was (3.79±0.85) . Compared with the control group, the differences were statistically significant ( P<0.01) . During hospitalization and one month after discharge, the complication rate of the research group was lower than that of the control group, and the difference was statistically significant ( P<0.05) . Conclusions:Nursing of theory education combined with experience education can improve the self-care ability of IPAH patients, improve their quality of life, and reduce the incidence of complications, which is worthy of clinical application.

With the continuous development of health care, people's awareness of health care is gradually enhanced. Pain has become an important part of disease rehabilitation and nursing. The research and evidence of pain assessment and management are increasing year by year. As the most direct assessor and manager of patients' pain, it is particularly important for nurses to identify and effectively manage different types of pain as soon as possible. In this background, the Registered Nurses' Association of Ontario (RNAO) released Clinical Best Practice Guidelines:Assessment and Management of Pain(Third Edition)in 2013. This article mainly introduces the development, application scope, methodology, main content, quality evaluation and subsidiary information of the guide.

The aim of this review is to realize the significance of physical activity for colorectal cancer survivors, collect the common tools to assess colorectal cancer patients' physical activity, understand the current status and its influencing factors of colorectal cancer patients' physical activity as a reference to Chinese relevant research and provide a basis for carrying out medical or nursing intervention.

Objective There have been few research on the relationship between expression of HDAC4 and chemotherapy resistance in human lung adenocarcinoma.The present study aims to investigate the expression and clinical significance of HDAC4 in human lung adenocarcinoma tissues.Methods We selected 72 tissues in lung adenocarcinoma patients with docetaxel-resistant from January 2006 to December 2007 in Department of Oncology and Thoracic Surgery, Nanjing General Hospital of Nanjing Military Region, then evaluated the recent efficacy according to the RECIST criteria and divided the tissues into sensitive(n=32, included complete remission and partial remission) and insensitive(n=40, included stability and progress) groups.The expression of HDAC4 in tissues≥the HDAC4 optimal relative expression cut-off value(78.7) was high level HDAC4 group(n=35), otherwise it was low level HDAC4 group(n=37).QRT-PCR analysis was performed to detect the HDAC4 expression levels in sensitive group and insensitive group.Analyzed the progression free survival in high level HDAC4 group and low level HDAC4 group.Results The expression of HDAC4 was significantly higher in the insensitive group compared with the sensitive group [(1.42±0.30) vs (0.60±0.15), P<0.01].The median progression free survival was significantly shortened in the high level HDAC4 group compared with the low level HDAC4 group (10.2 months vs 5.8 months, P<0.05).ConclusionThe expression of HDAC4 increased in docetaxel-resistant lung adenocarcinoma patients, and it is expected to be a predictive indicator of the resistance of docetaxel.

Objective To analyze and provide reference for developing clinical practice guidelines of ostomy care suitable for the domestic health care settings. Methods Content analysis method was used to analyze clinical practice guidelines searched from the Internet. Results A total of 13 clinical practice guidelines were included. All the guidelines were published between 2005 to 2016 without update. Four of them were evidence-based guidelines, the rest were not. A total of 21 items were identified as being related to ostomy care. Conclusions Although the existing clinical practical guidelines are instrumental to guiding clinical ostomy care practice, most of them were not evidence-based guidelines without high methodological quality. Meanwhile, some guidelines lack specific and updating recommendations for ostomy care, which may cause problems in ostomy care practice. What′s more, some recommendations may not suit for China because they were made in the foreign circumstance. Researchers and clinical nurses should develop local practice guidelines of ostomy care with consideration of the actual medical conditions in China and the best evidence.

Objective Human lung adenocarcinoma SPC-A1/DTX cells have a higher radioresistance than SPC -A1cells. This study was to investigate the role of Aurora-An/uclear factor κB ( NF-κB) in the radioresistance of human lung adenocarcinoma SPC-A1/DTX cells and its possible molecular mechanisms . Metho ds We collected human lung adenocarcinoma SPC-A1 and SPC A1/DTX cells and divided them into four groups:sh-Aurora-A ( Aurora-A plasmid interference ) , sh-NC, NF-κB inhibition ( SPC-A1/DTX +NF-κB inhibitor ) , and DMSO control .We measured the in vitro radio-sensitivity of the cells by MTT assay , determined their proliferation ability by cloning assay , and detected the mRNA and protein expressions of the target genes by real -time quantitative RT-PCR and Western blot , respectively . Results The 50% effective doses ( ED50 ) of the SPC-A1 and SPC-A1/DTX cells on radiotherapy were (6.5 ±0.3) and (12.8 ±0.6) Gy, respectively, with statisti-cally significant difference between the two groups ( P <0.01 ) .In the radiation doses of 0, 2, 4, and 6 Gy, the numbers of the cloned SPC-A1 cells were 345 ±20 , 252 ±22 , 170 ±15 , and 81 ±10 , sig-nificantly lower than those of the cloned SPC -A1/DTX cells (402 ±21, 370 ±18, 301 ±16, and 252 ±15) (P<0.05).The protein and mRNA expressions of Aurora-A were remarkably higher in the SPC-A1/DTX than in the SPC-A1 cells (1.00 ±0.08 and 1.00 ±0. 06 vs 0.49 ±0.03 and 0.22 ±0.02, P<0.05).MTT assay showed a higher ED50 in the sh-NC than in the sh-Aurora-A cells ([11. 8 ±0.5] vs [7.1 ±0.3] Gy, P<0.01) as well as in the control than in the NF-κB inhibition group ([11.7 ±0.5] vs [6.1 ±0.3] Gy, P<0.01).Inhibition of Aurora-A increased the expression of IκBa by 2.18 ±0.32 times (P<0.01) and that of NF-κB by 0.24 ±0.03 times (P<0.01).The expressions of IκBa (1.00 ±0.05) and NF-κB (1.00 ±0.04) were significantly lower in the parent strains of SPC-A1 than 0.65 ±0.04 and 2.18 ±0.15 in the drug-resistant strains of SPC-A1/DTX (P<0.01). Conclusi on Auro-ra-A/NF-κB is involved in the radioresistance of human lung adenocarcinoma SPC-A1/DTX cells.