AIM: To investigate the current status of retinopathy of prematurity(ROP)in premature infants in Xiamen and analyze its influencing factors, aiming to provide a scientific basis for clinical treatment and preventive strategies.METHODS: A retrospective study was conducted on the case data of 363 preterm infants with a gestational age of <32 wk who underwent fundus examination at Xiang'an Hospital of Xiamen University from February 11, 2020 to February 25, 2023. The incidence of ROP was statistically analyzed based on the screening results. All premature infants were divided into ROP group(37 cases, 64 eyes)and non-ROP group(326 cases, 652 eyes). General clinical data and perinatal-related information of the two groups were compared, and multivariate Logistic regression analysis was used to identify factors influencing the occurrence of ROP in premature infants.RESULTS: A total of 363 premature infants were included in this study. The fundus screening results showed that a total of 37 cases(64 eyes)of premature infants were detected with ROP, including 10 cases(10 eyes)monocular and 27 cases(54 eyes)binocular, with an overall incidence of 10.2%(37/363). The severity was determined according to the ROP international classification standard(ROP is divided into 5 stages, with stage I being the least severe and stage V the most severe). Among the 64 eyes, 30 eyes(46.9%)were in stage I, 20 eyes(31.3%)were in stage II, 10 eyes(15.6%)were in stage III, 4 eyes(6.3%)were in stage IV, and there were no cases in stage V. By comparing the clinical data of the two groups, no significant differences were found in gender, mode of delivery, singleton or multiple births, premature rupture of membranes, history of asphyxia, patent ductus arteriosus(PDA), or neonatal respiratory distress syndrome(NRDS)between the two groups(all P>0.05). However, premature infants in the ROP group had significantly younger gestational age and lower birth weight compared to those in the non-ROP group(all P<0.05). Additionally, the ROP group had higher proportions of longer hospital stays, bronchopulmonary dysplasia(BPD), neonatal sepsis, anemia, oxygen therapy for more than 1 wk, oxygen concentration above 40%, and blood transfusion treatment(all P<0.05). Multivariate Logistic regression analysis revealed that combined neonatal sepsis(OR=166.985, 95% CI: 35.239-791.277, P<0.001), anemia(OR=8.111, 95% CI: 2.064-31.871, P=0.003), oxygen use time >1 wk(OR=10.216, 95% CI: 2.543-41.039, P=0.001), oxygen therapy concentration >40%(OR=7.647, 95% CI: 1.913-30.566, P=0.004), and receiving blood transfusion therapy(OR=5.879, 95% CI: 1.412-24.470, P=0.015)were the main risk factors affecting the occurrence of ROP in preterm infants, and the higher birth weight of preterm infants was a protective factor for ROP(OR=0.093, 95% CI: 0.022-0.394, P=0.001).CONCLUSION: The incidence of ROP in premature infants is relatively high, and there are multiple influencing factors. Low birth weight, neonatal sepsis, anemia, oxygen therapy, and blood transfusion treatment are high-risk factors for ROP in premature infants. Clinical attention should be given to such infants, and fundus screening should be conducted in a standardized manner to provide early treatment, thereby further reducing the risk of ROP in premature infants.

Objective This study aimed to analyze the difference of clinical characteristics and risk factors for poor outcome between young patients and senior patients with spontaneous brainstem hemorrhage. Methods This was a retrospective study.The patients with spontaneous brainstem hemorrhage who presented to the Nanjing Drum Tower Hospital from January 2013 to January 2021 were enrolled in this study.They were divided into two groups:Youth group (18-59 years old) and Senior group (60-90 years old).General information and clinical data were collected.Univariate analysis was used to compare the clinical characteristics of the two groups,and multivariate logistic regression was used to analyze the independent risk factors for poor prognosis. Results A total of 202 eligible patients were enrolled in this study,including 136 patients in the Youth group and 66 patients in the Senior group.Univariate analysis of the clinical data from the two groups demonstrated that the prevalence of poor outcome,the proportion of male patients,coma on admission,surgery operation,complicated pneumonia and the average NIHSS score,volume of hematoma,DBP,TG were significantly higher in the Youth group than the Senior group (P<0.05).The average GCS score was remarkably lower in the Youth group(P<0.05).Early coma,low GCS score,high NIHSS score,large volume of hematoma,poor glycemic control,complicated pneumonia and Acinetobacter baumannii infection were risk factors for poor prognosis of both group.Multivariate logistic regression showed that low GCS score was an independent predictor for poor prognosis of both group. Conclusion Young patients with spontaneous brainstem hemorrhage had worse prognosis than elderly patients.Avoiding or effective control of risk factors might ameliorate the final outcome.

Objective:To deeply understand the real experience of young and middle-aged lymphoma patients returning to society.Methods:From August to September 2021, 17 young and middle-aged lymphoma patients admitted to the Department of Hematology of the First Affiliated Hospital with Nanjing Medical University were selected as the research object by objective sampling. Phenomenological research method was using to conduct face-to-face in-depth interviews. Colaizzi 7-step analysis method was used to summarize, analyze and refine the theme.Results:A total of 3 first-level themes and 10 second-level themes were extracted. Among them, the willingness to return to society included firm willingness of social return and negative attitude of social return. The scope of social return included returning to work, interpersonal communication, family responsibilities, leisure and entertainment and lifestyle. The influencing mechanism of social return was composed of disease and treatment factors, mental factors, external support and economic capacity.Conclusions:The experience of young and middle-aged lymphoma patients returning to society is a dynamic change process in many aspects. In the future, it is necessary to further explore the status quo of social return of such groups and explore the influencing factors and change tracks of heterogeneity.

Clinical phenotypes and gene characteristics of a patient diagnosed with Mowat-Wilson syndrome (MWS) with Hirschsprung′s disease (HSCR) and vaginal atresia in the Department of Neonatal Surgery, Beijing Children′s Hospital, Capital Medical University in March 2021 were analyzed retrospectively.The eight-month-old girl was admitted to the hospital with symptoms of constipation for nine days and abdominal distension for two days.Lower digestive tract radiography and rectal mucosa biopsy results suggested HSCR.The child also had specific facial features and motor development delay.Whole exome test showed a de novo heterozygous mutation, ZEB2 gene c. 2761C>T (p.R921*). After laparoscopic-assisted Soave procedure, the child had normal bowel movements, and no surgery-related compli-cations occurred during the follow-up period.The child′s motor development improved after rehabilitation treatment.According to literature review, 2 female cases show similar clinical manifestations to this girl, but the genotypes were different.This patient expands the clinical phenotype of ZEB2 gene pathogenicity.

Objective:To investigate the predictive value of matrix metalloproteinase-9 (MMP-9) and neutrophil to lymphocyte ratio (NLR) in delayed perihematomal edema (dPHE) after spontaneous intracerebral hemorrhage (sICH).Methods:Patients with sICH admitted to Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School within 24 h of onset from January 2018 to June 2020 were enrolled retrospectively. Serum MMP-9 levels and peripheral blood cell counts were detected, and NLR were calculated within 24 h of onset. dPHE was defined as an increase of 3 ml in absolute edema volume at 10-21 d after onset of sICH compared with that at 5-9 d. The demographic and baseline clinical and imaging data of the dPHE group and the non-dPHE group were compared. Multivariate logistic regression analysis was used to identify the independent predictors of dPHE. The receiver operating characteristic (ROC) curve was used to evaluate the predictive values of MMP-9 and NLR for dPHE. Results:A total of 195 patients with sICH (61.88±10.60 years old) were enrolled in the study. One hundred and forty-eight patients were males (75.9%). There were 53 patients (27.2%) in the dPHE group and 142 (72.8%) in the non-dPHE group. Univariate analysis showed that age, baseline hematoma volume, baseline National Institutes of Health Stroke Scale score, fasting blood glucose, high-sensitivity C-reactive protein, MMP-9, neutrophil count, NLR and the proportion of irregular hematoma in the dPHE group were significantly higher than those in the non-dPHE group (all P<0.05). Multivariate logistic regression analysis showed that after adjusting for confounding factors, higher MMP-9 (odds ratio [ OR] 4.291, 95% confidence interval [ CI] 2.041-6.590; P=0.007) and higher NLR ( OR 2.530, 95% CI 1.157-4.022; P=0.011) were all the independent predictors of dPHE. ROC curve analysis showed that the area under the curve of MMP-9 for predicting dPHE was 0.819 (95% CI 0.756-0.884; P<0.001), the optimal cut-off value was 164.0 μg/L, and the sensitivity and specificity were 86.79% and 66.90% respectively. The area under the curve of NLR for predicting dPHE was 0.788 (95% CI 0.719-0.856; P<0.001), the optimal cut-off value was 5.683, and the corresponding sensitivity and specificity were 77.36% and 71.13% respectively. Conclusions:sICH patients with higher baseline MMP-9 and NLR are more likely to develop dPHE. Early detection of MMP-9 and NLR in peripheral blood after admission can predict dPHE.

Objective:To provide reference for the development of a more intelligent and systematic nursing clinical decision support system based on the concept of precision nursing and data sharing, the nursing plan module of clinical decision support system.Methods:An evidence-based knowledge base was constructed based on the nursing process and the standardized nursing terminologies; the nursing plan module was designed according to clinical needs, and the logical reasoning rules were formulated from the generation, sequencing and stopping of nursing problems, objectives, measures and activities, and finally the nursing plan module of clinical decision support system was formed.Results:The nursing plan module of clinical decision support system included the basic information of patients, positive evaluation items and weight values, nursing problems, objectives, measures and activities, etc. the module could automatically deduce the nursing plan according to the patient's individual characteristic index (positive evaluation item), and sort the nursing problems and corresponding measures and activities according to the generation time, weight value and correlation degree. It could automatically distinguish nursing problems, goals, measures and the time of activity stop, and realize intelligent decision-making.Conclusion:The interface of nursing plan module of this system is clear and logical reasoning rules are rigorous. It breaks through the bottleneck of nursing decision-making based on personal professional knowledge and experience in clinical situation for a long time, which can ensure the homogeneity of nursing plan and improve the correctness of decision-making.

Objective:To design and develop an unplanned extubation clinical decision support system, aiming to provide a reference for nurses' clinical decision-making.Methods:Through literature review and expert consultation, the knowledge base of the clinical decision support system for unplanned extubation was constructed, and the system function and interface were designed.Results:The authoritative coefficients of the two rounds of expert consultation were 0.853 and 0.867, respectively, and the Kendall ′s W were 0.458 and 0.492, respectively. The final built knowledge base included catheter evaluation module, unplanned extubation evaluation module, and knowledge reasoning rule module. At present, the knowledge base had sorted out 48 first-level items, 9 second-level items, 72 third-level items in the catheter evaluation module, and 5 first-level items, 12 second-level items, and 73 third-level items in the unplanned extubation evaluation module. Entry, 40 knowledge reasoning rules. Conclusions:The clinical decision-making system for unplanned extubation has changed the implementation of unplanned extubation risk early warning, optimized the management process, and realized the interaction of the hospital system. It can conduct dynamic unplanned extubation risk assessment based on individualization and assist nurses Make clinical decisions and promote the safety of nursing management.

Objective:To introduce the construction process and results of the knowledge base in Nursing Decision Support System (NDSS) of the First Affiliated Hospital with Nanjing Medical University, in order to provide references for the development of nursing knowledge base.Methods:From July 2018 to March 2020, based on the "Knowledge Development Process" model, a knowledge base of NDSS covering the entire nursing process was constructed through literature review, expert meetings, and expert consultation methods.Results:The authority coefficients of two rounds of expert consultation were 0.875 and 0.925, and Kendall coordination coefficients were 0.464 and 0.534. The final built knowledge base includes nursing assessment module, nursing problem module, nursing goal module, nursing measure module, nursing activity module and matching rule module. Up to now, the knowledge sorted out 2 213 nursing assessments, 46 nursing questions, 67 nursing goals, 233 nursing goal measurement indexes, 183 nursing measures, 4 783 nursing activities and 3 332 matching rules.Conclusions:The construction process of the NDSS knowledge base has rules to follow and the content can cover the whole process of the nursing procedure. It focuses on the quantitative classification of nursing evaluation and nursing goals, as well as the individualization and pertinence of nursing measures, which can provide references for the development of clinical nursing knowledge base.

Objective:To explore research trends in the field of heart failure nursing.Methods:Web of Science database was searched and there trieval year was set to January 2000 to October 2020. CiteSpace software was used to visualize and quantitatively analyze the retrieval results.Results:A total of 2 352 articles were included. The number of articles published on heart failure nursing showed a continuous rise, and the highest number of articles issued was in 2018.The Journal with the highest number of publications was Journal of Clinical Nursing, the author with the highest number of publications was Tiny Jaarsm, the country with the highest number of publications was the United States, and the influential institution was University of Pennsylvania.Research hotspots mainly focused on management, outcome, mortality, quality of life, readmission, risk, hospitalization, survival, depression and palliative care. Conclusions:Visualization analysis shows the research trend in the field of heart failure nursing research, transitional nursing and community nursing are still the focus of future research.The visual analysis shows the research trend in the field of heart failure nursing, and transitional nursing and community nursing are still the research hotspots in the future.

Objective? To explore the status quo of thirst distress in patients with heart failure and its influencing factors and to provide a basis for developing intervention measures. Methods? Totally 445 patients with heart failure were selected from 3 ClassⅢ Grade A hospitals in Jiangsu and He′nan Provinces by convenient sampling, and investigated with the general information questionnaire, Thirst Distress Scale-Heart Failure (TDS-HF), Minnesota Heart Failure Quality of Life Scale (MLHFQ) and 24-hour Input and Output Record between August and December 2018. The influencing factors to thirst distress in patients with heart failure were also analyzed. Results? A total of 445 questionnaires were sent out, and 401 questionnaires were effectively recovered. The TDS-HF and MLHFQ scores of the patients with chronic heart disease were (21.98±9.70) and (57.77±28.34), and there was a positive correlation between the two (P=0.003). Univariate analysis revealed that there was a statistically significant difference in TED-HF scores between the patients with different body surface area, BMI,drinking alcohol or not,7 d fluid intake, 7 d fluid output, 7 d input-output difference, proportion of morning input, proportion of afternoon input, proportion of night input, cardiac function, left ventricular ejection fraction (LVEF), NT-proBNP, estimated plasma volume status (ePVS), with or without edema and estimated glomerular filtration rate (eGFR) (P＜0.05). Multiple linear regression analysis was conducted taking TDS-HF scores as dependent variables and the statistically significant variables found in univariate analysis as independent variables. The results showed that patients′ BMI, body surface area, 7 d fluid intake, 7 d input-output difference, proportion of morning input, proportion of afternoon input, cardiac function, ePVS, edema grading and eGFR were the main influencing factors to thirst distress in patients with heart failure (P＜ 0.05). Conclusions? The thirst distress is severe in patients with heart failure, which is affected by limited water, individual variation between patients and disease conditions. It is necessary for medical and nursing workers develop targeted intervention measures, reduce thirst distress while achieving the best outcomes, and improve the patients′ quality of life.