Objective:To investigate the characteristics of cognitive frailty and its influencing factors in older patients with chronic heart failure.Methods:In this cross-sectional study, 300 older patients hospitalized for chronic heart failure in a tertiary hospital in Shandong Province between September 2021 and September 2022 were selected.A general information questionnaire, the mini-nutritional assessment scale-short form(MNA-SF), the athens insomnia scale(AIS), the ulca loneliness scale, the geriatric depression scale-5 item version(GDS-5), and the social support rating scale(SSRS)were used for assessment and influencing factors were identified by univariate and Logistic regression analysis.Results:Among 300 older patients with chronic heart failure, the prevalence of cognitive frailty was 75.3%(226 cases). Logistic regression analysis showed that age between 70-79 years( OR=0.543, 95% CI: 0.299-0.987), education level( OR=3.644, 95% CI: 1.780-7.461), weekly intellectual activity( OR=2.168, 95% CI: 1.082-4.334)and loneliness( OR=1.101, 95% CI: 1.032-1.175)were factors influencing cognitive frailty in older patients with chronic heart failure. Conclusions:The prevalence of cognitive frailty in older patients with chronic heart failure is high, and age, education level, weekly intellectual activity and loneliness are influencing factors, with education level having the greatest impact on older patients with chronic heart failure.

Objective To investigate the effects of a multi-component exercise nursing intervention on frailty,activities of daily living and quality of life in elderly patients with chronic heart failure.Methods Through literature analysis and expert meeting,the multi-component exercise nursing intervention program was formed.A total of 71 elderly patients with chronic heart failure who admitted from January 2022 to September 2022 in a tertiary A hospital in Shandong Province were randomly divided into an intervention group(35 cases)and a control group(36 cases).The control group received usual care,while the intervention group received an additional multi-component exercise nursing training.2 groups were evaluated by Tilburg frailty indicator scale,modified Barthel index scale and 12-item short form health survey scale before the intervention,4 weeks and 12 weeks after the intervention.Results A total of 62 patients(31 in the experimental group and 31 in the control group)completed the study.Generalized estimation equation results showed that the inter-group effect,time effect and interaction effect of frailty,activities of daily living and quality of life in the 2 groups were statistically significant(P＜0.05).At 4 weeks and 12 weeks after the intervention,the Tilburg Frailty Indicator scale scores in the intervention group were lower than that in the control group(P＜0.05),and the scores of the modified Barthel index scale and 12-item short form health survey scale were significantly higher than those in the control group(P＜0.05).Conclusion The multi-component exercise nursing intervention can effectively improve frailty,activities of daily living and quality of life in elderly patients with chronic heart failure.

Abstract Allergic diseases can occur in all systems of the body, covering the whole life cycle, from children to adults and to old age, can be lifelong onset and even fatal in severe cases. Children account for the largest proportion of the victims of allergic disease, Children s allergies start from scratch, ranging from mild to severe, from less to more, from single to multiple systems and systemic performance, so the prevention and treatment of allergic diseases in children is of great importance, which can not only prevent high risk allergic conditions from developing into allergic diseases, but also further block the process of allergy. At present, there is no consensus on the management system of allergic children in kindergartens and primary schools. The "Consensus on Allergy Management and Prevention in Kindergartens and Primary Schools", which includes the organizational structure, system construction and management of allergic children, provides evidence informed recommendations for the long term comprehensive management of allergic children in kindergartens and primary schools, and provides a basis for the establishment of the prevention system for allergic children.

Objective:To explore the mediating roles of family resilience and perceived social support between fear of progression and quality of life in patients with adult pulmonary hypertension, so as to provide guidance for grassroots medical staff to deeply understand and improve the long-term quality of life of adult pulmonary hypertension patients.Methods:Using a convenience sampling method, 219 adult pulmonary hypertension patients who attended Qilu Hospital, Shandong University from July 2021 to February 2022 were selected for a cross-sectional study using the World Health Organization Quality of Life Questionnaire Abbreviated Version (WHOQOL-BREF), Perceived Social Support Scale (PSSS), Shortened Chinese version of the Family Resilience Assessment Scale (FRAS-C) and Chinese version of Fear of Progression Questionnaire-Short Form (FoP-Q-SF) for investigation. A structural equation model was established to evaluate the mediating effect of family resilience and perceived social support on fear of progression and quality of life.Results:The scores of WHOQOL-BREF, PSSS, FRAS-C, and FoP-Q-SF were (45.85 ± 10.22), 66(56, 75), 94(89, 97) and 39(32, 46) points in adult pulmonary hypertension patients. The total scores of WHOQOL-BREF were negatively correlated with FoP-Q-SF ( r = -0.63, P<0.01), and positively correlated with FRAS-C and PSSS ( r=0.54, 0.46, both P<0.01). Family resilience played a partial mediating role between fear of progression and quality of life, accounting for 13.43% of the total effect. Family resilience and perceived social support played a chain mediating role between fear of progression and quality of life, accounting for 2.71% of the total effect. Conclusions:Family resilience-perceived social support play mediating roles between fear of progression and quality of life, healthcare workers can alleviate fear of progression and improve quality of life by promoting the levels of family resilience and perceived social support of adult pulmonary hypertension parents.

Objective:To evaluate nutritional status in elderly patients with chronic heart failure and to investigate its association with unplanned readmission.Methods:From July 2020 to August 2021, 220 elderly patients hospitalized for chronic heart failure in Qilu Hospital of Shandong University were enrolled in a prospective cohort study. Basic information, laboratory tests and other data of the patients were collected. Nutritional status of the patients was assessed by geriatric nutritional risk index and the patients were divided into groups. Data were analyzed by R4.1.1 and SPSS26.0, survival curves were drawn by Kaplan-Meier method, and the relationship between nutritional status and unplanned readmission in elderly patients with chronic heart failure was analyzed by univariate and multivariate Cox regression.Results:Among 220 elderly patients with chronic heart failure, 59.5%(131/220) were in normal nutrition. There were 40.5%(89/220) in the malnutrition, including 26.8%(59/220) in the mild malnutrition and 13.6%(30/220) in the moderate and severe malnutrition. During the follow-up period of 3 months, 25.9% (57/220) had unplanned readmission. Kaplan-Meier survival curve showed that the incidence of unplanned readmissions was higher in the moderate and severe malnutrition than in the normal and mild malnutrition, and the difference among them was statistically significant ( P<0.05). Multivariate Cox regression analysis showed that moderate and severe malnutrition was an independent predictor of unplanned readmission in elderly patients with chronic heart failure ( HR=2.064, 95% CI 1.029-4.138, P<0.05). Conclusions:The prevalence of malnutrition in elderly patients with chronic heart failure is high. Moderate and severe malnutrition is an independent predictor of unplanned readmission in elderly patients with chronic heart failure. The geriatric nutritional risk index is an effective screening tool and can provide a reference for clinical evaluation of nutritional risk in patients.

Objective:To explore the clinical characteristics of chronic kidney disease (CKD) at the stage 3-5D in children with renal anemia, and provide reference data for standardized diagnosis and treatment.Methods:A single-center retrospective study was conducted to collect clinical data in children with CKD at Beijing Children's Hospital Affiliated to Capital Medical University from January 2016 to December 2018. The patients were divided into CKD stage 3 group, stage 4 group and stage 5 group according to estimated glomerular filtration rate. The indexes of anemia among the groups were compared. Data on anemia indicators, treatment, and anemia improvement in maintenance dialysis children at stage 5D were analyzed.Results:A total of 171 children with CKD were included in the study. The hemoglobin levels in CKD stage 3 group, stage 4 group and stage 5 group were (126.4±20.5) g/L, (90.8±26.0) g/L and (78.7±18.4) g/L, respectively, and there was a statistical difference among the groups ( χ2=61.982, P<0.001; trend test F=71.061, P<0.001). The incidences of anemia in children with CKD stage 3, stage 4 and stage 5 were 27.3% (9/33), 83.3% (25/30) and 95.4% (105/108), respectively. Mild, moderate and severe anemia in children with CKD stage 3 accounted for 15.2%(5/33), 12.1% (4/33) and 0(0), respectively. Mild, moderate and severe anemia in children with CKD stage 4 accounted for 26.7% (8/30), 50.0% (15/30) and 6.7% (2/30), respectively. Mild, moderate and severe anemia in children with CKD stage 5 accounted for 21.3%(23/108), 60.2%(65/108) and 15.8%(17/108), respectively. Anemia type was mostly normocytic anemia. The hemoglobin of 30 children with CKD stage 5D at the initial stage of dialysis was (79.3±16.3) g/L. Twenty-three children with CKD stage 5D received erythropoietin combined with oral iron or intravenous iron therapy. The hemoglobin compliance rates in children with maintenance dialysis in initial phase, 1 month, 2 months and 3 months were 6.7% (2/30), 16.7%(5/30), 63.3%(19/30) and 90.0%(27/30), respectively. The correction time for anemia was (2.5±1.0) months. Twelve children with CKD stage 5D received iron sucrose infusion, and no adverse reaction occurred. Conclusions:Renal anemia has a high incidence in children with CKD. Early and standardized treatment is of great significance to improve outcome of renal anemia. Venous iron infusion is a safe and effective treatment method for children with maintenance dialysis.

Objective:To investigate the clinical features and prognosis of extranodal nasal-type NK/T-cell lymphoma of the extra-upper aerodigestive tract (extra-UADT NKTCL).Methods:The clinical data of 159 patients with extra-UADT NKTCL from the China Lymphoma Collaborative Group (CLCG) database between November 2001 and December 2015 were retrospectively analyzed. Kaplan-Meier survival analysis and Log-rank test were used to evaluate the prognosis. The Cox regression model is used for multi-factor analysis.Results:Extra-UADT NKTCL commonly occurs in skin and soft tissues (106/159, 66.7%) and gastrointestinal tract (31/159, 19.5%). The incidences of elevated lactate dehydrogenase (LDH) and Ann Arbor Ⅲ~Ⅳ stage were 47.8% (76/159) and 64.2% (102/159), respectively. The 3-year overall survival (OS) and progression-free survival (PFS) rates were 43.6% and 27.9%, respectively. The corresponding OS rates of primary skin/soft tissue site and gastrointestinal tract site were 41.0% and 59.4% ( P=0.281), while the PFS rates were 24.8% and 48.3%, respectively ( P=0.109). Combined modality treatment improved the 3-year OS of all the patients (58.4% vs 33.9%, P=0.001) and 3-year PFS (40.7% vs 20.7%, P=0.008) when compared with chemotherapy alone. LDH elevation, Ann Arbor synthesising and ≥2 junction external bits were intrusive as independent risk factors for total survival ( P<0.05), LDH elevation and ≥2 junction outer bits were intrusive as independent risk factors for progressionless survival( P<0.05). The distant extranodal dissemination was the primary failure patterns. Conclusions:Extra-UADT NKTCL appears to have distinct clinical characteristics and poor outcome. Compared with chemotherapy alone, combined modality treatment may improve the prognosis of patients with extra-UADT NKTCL.

Objective:To evaluate the prognosis and determine the failure patterns after radiotherapy for low-risk early-stage patients with extranodal NK/T-cell lymphoma, nasal-type (ENKTCL).Methods:A total of 557 patients from 2000—2015 with low-risk early-stage ENKTCL who received radiotherapy (RT) with or without chemotherapy (CT) from China Lymphoma Collaborative Group were retrospectively reviewed. Among them, 427 patients received combined modality therapy, whereas 130 patients received RT alone. Survivals were calculated by Kaplan-Meier method and compared with Log-rank test. Overall survival (OS) was compared with age and sex-matched general Chinese population using expected survival and standardized mortality ratio (SMR). Cox stepwise regression model was used for multivariate analysis.Results:The 5-year OS and progression-free survival (PFS) were 87.2% and 77.2%. The SMR was 3.59 ( P<0.001) at 1 year after treatment, whereas it was 1.50 at 4 years after treatment, without significant difference between ENKTCL group and country-matched general population ( P=0.146). Compared with RT alone, CMT did not result in significantly superior 5-year OS (87.0% vs 87.4%, P=0.961) or PFS (76.1% vs 80.7%, P=0.129). Local failure (11.5%, 64/557) and distant failure (10.8%, 60/557) were the main failure modes, while regional failure was rare (2.9%, 16/557). The 5-year locoregional control rate (LRC) was 87.2% for the whole group, with 89.5% for ≥50 Gy versus 73.7% for <50 Gy ( P<0.001). Radiotherapy dose was an independent factor affecting LRC( P<0.05). Conclusions:Radiotherapy achieves a favorable prognosis in patients with low-risk early-stage ENKTCL. The incidence of either locoregional or distant failure is low. Radiation dose still is an important prognostic factor for LRC.

Objective:To investigate the clinical features and prognosis of extranodal nasal-type NK/T-cell lymphoma of the extra-upper aerodigestive tract (extra-UADT NKTCL).Methods:The clinical data of 159 patients with extra-UADT NKTCL from the China Lymphoma Collaborative Group (CLCG) database between November 2001 and December 2015 were retrospectively analyzed. Kaplan-Meier survival analysis and Log-rank test were used to evaluate the prognosis. The Cox regression model is used for multi-factor analysis.Results:Extra-UADT NKTCL commonly occurs in skin and soft tissues (106/159, 66.7%) and gastrointestinal tract (31/159, 19.5%). The incidences of elevated lactate dehydrogenase (LDH) and Ann Arbor Ⅲ~Ⅳ stage were 47.8% (76/159) and 64.2% (102/159), respectively. The 3-year overall survival (OS) and progression-free survival (PFS) rates were 43.6% and 27.9%, respectively. The corresponding OS rates of primary skin/soft tissue site and gastrointestinal tract site were 41.0% and 59.4% ( P=0.281), while the PFS rates were 24.8% and 48.3%, respectively ( P=0.109). Combined modality treatment improved the 3-year OS of all the patients (58.4% vs 33.9%, P=0.001) and 3-year PFS (40.7% vs 20.7%, P=0.008) when compared with chemotherapy alone. LDH elevation, Ann Arbor synthesising and ≥2 junction external bits were intrusive as independent risk factors for total survival ( P<0.05), LDH elevation and ≥2 junction outer bits were intrusive as independent risk factors for progressionless survival( P<0.05). The distant extranodal dissemination was the primary failure patterns. Conclusions:Extra-UADT NKTCL appears to have distinct clinical characteristics and poor outcome. Compared with chemotherapy alone, combined modality treatment may improve the prognosis of patients with extra-UADT NKTCL.

Objective:To evaluate the prognosis and determine the failure patterns after radiotherapy for low-risk early-stage patients with extranodal NK/T-cell lymphoma, nasal-type (ENKTCL).Methods:A total of 557 patients from 2000—2015 with low-risk early-stage ENKTCL who received radiotherapy (RT) with or without chemotherapy (CT) from China Lymphoma Collaborative Group were retrospectively reviewed. Among them, 427 patients received combined modality therapy, whereas 130 patients received RT alone. Survivals were calculated by Kaplan-Meier method and compared with Log-rank test. Overall survival (OS) was compared with age and sex-matched general Chinese population using expected survival and standardized mortality ratio (SMR). Cox stepwise regression model was used for multivariate analysis.Results:The 5-year OS and progression-free survival (PFS) were 87.2% and 77.2%. The SMR was 3.59 ( P<0.001) at 1 year after treatment, whereas it was 1.50 at 4 years after treatment, without significant difference between ENKTCL group and country-matched general population ( P=0.146). Compared with RT alone, CMT did not result in significantly superior 5-year OS (87.0% vs 87.4%, P=0.961) or PFS (76.1% vs 80.7%, P=0.129). Local failure (11.5%, 64/557) and distant failure (10.8%, 60/557) were the main failure modes, while regional failure was rare (2.9%, 16/557). The 5-year locoregional control rate (LRC) was 87.2% for the whole group, with 89.5% for ≥50 Gy versus 73.7% for <50 Gy ( P<0.001). Radiotherapy dose was an independent factor affecting LRC( P<0.05). Conclusions:Radiotherapy achieves a favorable prognosis in patients with low-risk early-stage ENKTCL. The incidence of either locoregional or distant failure is low. Radiation dose still is an important prognostic factor for LRC.