Objective:To investigate the predictive value of serum levels of C-C motif chemokine ligand 21 (CCL21) and C-X-C motif chemokine receptor 3 (CXCR3) for stroke-associated pneumonia (SAP) in patients with acute ischemic stroke (AIS).Methods:Patients with AIS admitted to No.215 Hospital of Shaanxi Nuclear Industry from July 2020 to December 2023 were prospectively included. Serum CCL21 and CXCR3 test results and general clinical data at admission were collected using the hospital electronic medical record system. The independent influencing factors of SAP were identified through multivariate logistic regression analysis, and the predictive value of serum CCL21 and CXCR3 levels for SAP were analyzed by receiver operating characteristic (ROC) curves. Results:A total of 150 patients with AIS were enrolled, including 91 males (60.67%), aged 61.48±7.92 years. Among them, 41 patients (27.33%) developed SAP during hospitalization. There were significant differences in serum CCL21 and CXCR3 levels, National Institutes of Health Stroke Scale score, Glasgow Coma Scale score, invasive mechanical ventilation, length of hospital stay, and the proportion of patients with hypertension and diabetes between the SAP group and the non-SAP group (all P<0.05). Multivariate logistic regression analysis showed that serum CCL21 (odds ratio [ OR] 1.022, 95% confidence interval [ CI] 1.006-1.039; P=0.006) and CXCR3 ( OR 1.036, 95% CI 1.018-1.054; P<0.001) levels were the independent risk factors for SAP. ROC curve analysis showed that serum CCL21 and CXCR3 levels had good predictive power separately for SAP. The areas under the curve was 0.730 (95% CI 0.634-0.825) and 0.807 (95% CI 0.721-0.892), respectively. The combined prediction of the two showed an area under the curve of 0.881 (95% CI 0.819-0.943). Conclusion:The patients with AIS generally have higher levels of serum CCL21 and CXCR3. The levels of serum CCL21 and CXCR3 are closely associated with SAP, and both of them have a good predictive effect on SAP alone or in combination.

Objective To investigate the effect of roflumilast on pulmonary injury induced by Streptococcus pneu-monia(SP)in rat model.Methods Rats were randomly divided into control group,pneumonia model group,roflu-milast low dose group,high dose group and roflumilast high dose plus Colivelin(STAT3 activator)intervention group.The level of PaO2,PaCO2,IL-1β,IL-8,IL-10 and TNF-α were detected.Lung tissue wet/dry ratio(W/D),MDA content,MPO and SOD activity were examined.HE staining microscopy was used to observe the pathological injury of lung tissue.Apoptosis,cleaved caspase-3,IL-6,and p-STAT3/STAT3 protein expression were detected.Results Compared with the control group,the lung tissue of animals in the model group showed obvious damage;blood PaO2,oxygenation index(OI),lung tissue IL-10 level,and SOD activity were all significantly reduced;the level of blood PaCO2,lung tissue IL-1β,IL-8,TNF-α and W/D values,MDA content,MPO activity,cell apoptosis rate,cleaved caspase-3,IL-6,and p-STAT3/STAT3 protein expression were significantly increased(P＜0.05).Compared with the model group,the lung tissue damage of rats in the low and high dose groups of roflumilast was obviously reduced;the level of blood PaO2,OI and,lung tissue IL-10,and SOD activity were obviously increased,the level of blood PaCO2,lung tissue IL-1β,IL-8,TNF-α and,W/D values,MDA content,MPO activity,cell apoptosis rate,cleaved caspase-3,IL-6,and p-STAT3/STAT3 protein expression were significantly reduced(P＜0.05);Colivelin was able to partially reverse the improvement effect of roflumilast on lung injury in rats with SP pneumonia(P＜0.05).Conclusions Roflumilast may inhibit inflammatory response,oxidative damage and ap-optosis of SP-induced pneumonia in rats resulting in an improvement of lung function.

Objective:To explore the mediating effect of distress disclosure between perceived social support and psychological distress in colorectal cancer patients.Methods:The convenient sampling method was used to select 220 postoperative colorectal cancer patients who were reviewed in China-Japan Union Hospital of Jilin University from February to August 2023 as the research objetcs. The Distress Disclosure Index (DDI), Perceived Social Support Scale (PSSS), and Chinese version of Screening Tool for Psychological Distress in Cancer Patients were used to conduct the survey.Results:A total of 220 questionnaires were distributed in this study, and 213 valid questionnaires were recovered, with a valid recovery rate of 96.82%. The total score of the Chinese version of Screening Tool for Psychological Distress in Cancer Patients for colorectal cancer patients was (4.31±2.46), the total score of the DDI was (37.26±9.97), and the total score of the PSSS was (57.82±14.60). Pearson correlation analysis showed that psychological distress was negatively correlated with distress disclosure in colorectal patients ( P<0.01), distress disclosure was positively correlated with perceived social support ( P<0.01), and psychological distress was negatively correlated with perceived social support ( P<0.01). The mediating effect results showed that the direct effect of perceived social support on psychological distress was -0.359 ( P<0.01), and the mediating effect between perceived social support and psychological distress was -0.227 ( P<0.01), which acted as a partial mediating effect with the mediating effect accounting for 38.74% of the total effect. Conclusions:Perceived social support can not only directly affect the psychological distress of colorectal cancer patients, but also indirectly affect psychological distress through distress disclosure. Clinical staffs should take certain interventions to improve the level of patients' perceived social support and distress disclosure, so as to improve the psychological distress of patients.

An adult female patient of internal nuclear inclusion disease(NIID)with a major clinical manifestation of decreased intelligence and recurrent disturbance of consciousness was followed up for nearly 4 years.In particular,the evolution of the video-electroencephalogram(VEEG),the auxiliary diagnosis of VEEG,and the prediction value of VEEG for clinical outcome were summarized.We found that(1)the background rhythm in NIID patients evolved with the progression of the disease;(2)electroencephalogram reactivity could predict the outcome of NIID coma;(3)VEEG helped to determine whether the consciousness disturbance caused by NIID was due to non-convulsive status epilepticus,This case provides a new idea to explore the application of VEEG in NIID.

Objective:To explore the obstacle factors and promoting factors of exercise guidance and implementation after breast cancer surgery, so as to provide reference and basis for the formulation of exercise program after breast cancer patients.Methods:Using the objective sampling method, a total of 10 medical staff and 10 patients with breast cancer after operation from the breast surgery department of the Seven People's Hospital Affiliated to Shanghai University of Traditional Chinese Medicine hospital in Shanghai were selected as research objects from July to September 2022. A semi-structured interview was conducted. The interview outline was developed based on the knowledge transformation framework, and the results were analyzed by the content analysis method.Results:The study extracted three levels of influencing factors. The system level included caregiver workload, educational materials, norms and responsibilities and trust in evidence-based evidence. The practitioner level included the level of exercise knowledge, the concern about patient compliance and the emphasis on exercise. The patient level included sports knowledge level, personality and interest, venous line, adverse reaction of treatment, psychological state, weather environment, attention to health and concern of family members.Conclusions:The medical staff need to consider the postoperative exercise guidance for breast cancer patients from the department, themselves and patients, and should fully consider the patients' conditions and subjective experience to improve the patients' exercise compliance.

Objective:To investigate the post competency of "Academic-Practical" of clinical nursing teachers, and analyze related influencing factors.Methods:A total of 312 "Academic-Practical" and "Non-Academic-Practial" clinical nursing teachers from The Affiliated Hospital of Southwest Medical University were surveyed by the Clinical Nursing Teacher Post Competency Evaluation Questionnaire. SPSS 20.0 software was used for t test, chi-square test and rank sum test. Results:The average self-evaluation scores of post competency of "Academic-Practical" clinical nursing teachers were (4.26±0.41) points, which were higher than those of the "Non-Academic-Practical" teachers [(3.19 ±0.50) points], showing good post competency. There were significant differences in the scores of professional quality (17.39±1.54), professional attitude (21.75±2.21), professional ability (21.14±2.31), teaching ability (50.39±5.93), interpersonal coordination ability (25.57±3.04), and personality characteristics (17.27±2.04) between the "Academic-Practical" and "Non-Academic-Practical" teachers (all P<0.01). And there were significant differences in self-evaluation post competency scores of "Academic-Practical" teachers in "with or without teacher qualification certificate" ( P=0.001), "whether she/he is the backbone of the department" ( P=0.002), degree ( P=0.001), age ( P<0.001), positional title ( P<0.001) and working year ( P<0.001) (all P<0.01). But there was no significant difference in gender ( P=0.735) and "whether she/he is a specialized nurse" ( P=0.335). Conclusion:"Academic-Practical" and "Non-Academic-Practical" medical teachers should take the post competency as the core orientation, adopt the "Ladder" mode of training and management, and constantly improve the training plan of post competencey.

Objective:To explore the effect of pain threshold reduction nursing in patients with chronic non-healing wounds.Methods:From December 2017 to December 2020, convenience sampling was used to select 122 patients with chronic non-healing wounds in the China-Japan Friendship Hospital of Jilin University as the research object. According to the lottery method, the patients were divided into the control group and the observation group. The control group conducted conventional nursing, and the observation group carried out the pain threshold reduction nursing on the basis of the control group for a total of 2 weeks of nursing care. Wound edema, wound healing score, wound healing time, wound healing rate, Visual Analogue Scale (VAS) score were compared between the two groups of patients. The hospital stay and medical expenses of the two groups were compared.Results:The edema score at 48 hours after operation and wound healing score before discharge in the observation group were lower than those in the control group, and the difference was statistically significant ( P<0.01) . The wound healing time of the observation group was shorter than that of the control group, and the wound healing rate was higher than that of the control group, and the difference was statistically significant ( P<0.01) . The VAS scores of patients in the observation group before and after debridement and after nursing were lower than those of the control group, and the difference was statistically significant ( P<0.01) . The hospital stay and medical expenses of patients in the observation group were less than those in the control group, and the difference was statistically significant ( P<0.01) . Conclusions:Pain threshold reduction nursing can effectively improve the healing of patients' chronic wounds, promote wound repair, and increase the patient's tolerance to pain, further shorten the patient's hospital stay, and reduce the economic pressure of patients.

Objective:To construct an artificial intelligence model for the diagnosis of facial vitiligo, so as to realize artificial intelligence-assisted diagnosis of facial vitiligo.Methods:Based on digital single-lens reflex (SLR) camera images of vitiligo skin lesions and YOLO (You Only Look Once) v3 algorithm, a skin lesion detection model Vit3 was established, and its performance was evaluated by comparing its detection results and labeling results of dermatologists. On the basis of the Vit3 model, both optical and ultraviolet images of vitiligo and non-vitiligo skin lesions were taken by using an artificial intelligence-based facial skin image collector, and the gray values of vitiligo and non-vitiligo skin lesion areas on the ultraviolet images were measured by using an image processing technique. According to the gray-value threshold between vitiligo and non-vitiligo skin lesions, a facial vitiligo diagnosis model Vit4 was established. Cochran′s Q test was used to compare the diagnostic results of the Vit4 model and dermatologists, and the diagnostic performance of the Vit4 model was evaluated. Results:For 100 SLR camera images of vitiligo skin lesions (167 lesional sites) and 100 SLR camera images of normal skin, the diagnostic sensitivity of the Vit3 model was 92.81% (155/167) . For 97 pairs of facial skin images (including 50 vitiligo lesions, 30 pityriasis alba lesions, 7 amelanotic nevus leisons, and 10 normal skin tissues) , the diagnostic accuracy rate, sensitivity and specificity of the Vit4 model were 88.66% (86/97) , 88.00% (44/50) and 89.36% (42/47) respectively, and there was no significant difference in the diagnostic accuracy rate between the Vit4 model and dermatologists (92.78%[90/97], χ2=2.323, P > 0.05) . Conclusion:The artificial intelligence model Vit4 was established for the diagnosis of facial vitiligo with favorable diagnostic performance, and could serve as an objective and convenient method for the auxiliary diagnosis of facial vitiligo.

Atherosclerosis is an inflammatory disease which mediated by the immune system of the arterial wall. Specific and non-specific immune systems of arterial wall showed positive immunore action with many endogenous and exogenous antigens.Studies have shown that the immune system promotes atherosclerosis on the one hand and delays atherosclerosis on the other. Therefore,the progress of atherosclerosis can be regulated through activating immune regulation. In this review,the double effects of specific and non-specific immune systems on the process of atherosclerosis were discussed. The studies of those antigen which have been made into vaccines and successfully delayed the process of atherosclerosis in laboratory models were introduced. And the prospects and challenges for future clinical application of atherosclerosis vaccines were discussed in this review.

Statistics show that 76.74% (4 688) of 6 109 patients with chronic wounds are those over 50 years of age; the proportion of patients with underlying diseases in all age groups above 50 years ranges from 78.25% to 100.00%; among the underlying diseases of chronic wound patients, the top four diseases are diabetes mellitus , cardiovascular and cerebrovascular diseases, hypertension, and respiratory diseases. The above underlying diseases and ages of patients are the susceptibility factors of corona virus disease 2019 released by National Health Commission of China. It is an unavoidable fact that patients with chronic wounds have to go to the hospital for treatment prescribed by the physician. At the same time, we found that there were not a few patients who go far afield because of various reasons when go to the hospital for treatment. During the period of epidemic prevention and control, this kind of "go far afield" style of seeking medical treatment may increase the exposure risk during transportation. Accordingly, we convened 36 wound care clinics in different regions in Shanghai to implement the "Five Measures" to encourage patients with chronic wounds to seek medical treatment proximately. The principle of this operation is that when seeking medical treatment, trying our best to reduce as much as possible the transportation distance for patients with chronic wounds to minimize the exposure risk during the epidemic period and eventually support the epidemic prevention and control campaign.