Objective:To investigate the impact of the deep-learning-based CT fractional flow reserve (CT-FFR) on clinical decision-making and long-term prognosis in patients with obstructive coronary heart disease.Methods:In this single-center retrospective cohort study, consecutive patients with obstructive coronary heart disease (with at least one stenosis≥50%) on their first coronary computed tomography angiography (CCTA) in Beijing Anzhen Hospital from February 2017 to July 2018 were included. Baseline clinical and CT characteristics were collected. Deep-learning-based CT-FFR and Leiden CCTA risk score were calculated. All patients enrolled were followed up for at least 5 years. The study endpoint was major adverse cardiovascular events (MACE), defined as the composite of cardiac death, nonfatal myocardial infarction, unstable angina requiring hospitalization, and unplanned revascularization. Receiver operating characteristic (ROC) curves were drawn to define the optimal cut-off point of the Leiden score in predicting the 5-year MACE, and survival analysis and Cox regression were performed to explore the related factors of MACE.Results:A total of 622 patients, aged 61 (54, 66) years, with 407 (65.4%) males were included. Diagnostic coronary angiography was performed in 78 patients after their baseline CCTA, with 34 (43.6%) patients had CT-FFR>0.80. During a follow-up time of 2 181 (2 093, 2 355) days, 155 patients (24.9%) suffered from MACE. ROC derived optimal cut-off point of Leiden score for predicting MACE was 15.48. Survival analysis found that male patients, Leiden risk score>15 and CT-FFR≤0.80 had worse prognosis. Multivariate Cox regression analysis identified CT-FFR≤0.80 as an robust and independent predictor of MACE ( HR=4.98, 95% CI 3.15-7.86, P<0.001). Conclusion:Deep-learning-based CT-FFR aids in clinical decision-making and the evaluation of long-term prognosis in patients with obstructive coronary heart disease.

Objective: To understand the needs of parents of kindergarten children in urban areas for online training on sexuality education, so as to provide a basis for the development of parent training courses. Methods: In May 2023, a multistage cluster random sampling method was used to select 3 516 parents of young children from 12 kindergartens in urban areas of Changshou District, Chongqing. A self designed questionnaire on Knowledge, Attitude and Practice of Early Childhood Sexuality Education (Parents) was used for the survey, and χ 2 test and multi factor Logistic regression model were used for data analysis. Results: The online training demand rate of urban parents for early childhood sexuality education was 57.05%. The results of the multi factor Logistic regression analysis showed that age, education level, occupation, whether or not they were the main caregivers, total score level of the scale, awareness of their own responsibility, communication with family and friends about early childhood sexuality education and young children s participation in kindergarten sexuality education activities were the influencing factors of parents online training demand on sexuality education ( OR =1.18, 1.44, 1.42, 0.83, 1.19, 0.51, 0.75, 0.75, P <0.05). Conclusion Urban parents have a high demand for online training on early childhood sexuality education, and training courses should be developed according to the specific needs and characteristics of parents of young children.

Objective:To summarize the best evidence for the prevention and management of oral mucosal pressure injury (OMPI) in severe neurological patients with tracheal intubation.Methods:The clinical decisions, guidelines, expert consensus, evidence summary, systematic reviews, and clinical practice regarding the prevention and management of OMPI in severe neurological patients with tracheal intubation were searched in domestic and foreign databases, guideline websites, and professional association websites. The search period was from database establishment to May 30, 2023. Four researchers who undergone systematic evidence-based training conducted literature quality evaluation and evidence extraction.Results:A total of 15 articles were included, including three evidence summaries, three systematic reviews, two guidelines, three clinical practices, three expert consensus, and one clinical decision. A total of 27 pieces of best evidence were summarized from six aspects of risk assessment, oral mucosal assessment, oral nursing, tracheal intubation management, nutritional support, and organizational training.Conclusions:The best evidence for the prevention and management of OMPI in severe neurological patients with tracheal intubation summarized provides evidence-based evidence for medical and nursing staff to prevent and manage OMPI in severe neurological patients with tracheal intubation.

Objective By employing surgically induced varicocele(VC)in SD rats and an apomorphine(APO)test,we screened rats with erectile dysfunction(ED)after VC and explored method to establish VC and ED models.Methods Sixty rats were randomly divided into Control,Sham,and Model groups with 20 rats in each group.Using the Turner method,we partially ligated the left renal vein to induce left VC three times.APO tests were conducted to screen rats with ED after inducing VC.The numbers of erections,genital grooming,and yawning were observed and recorded.The diameter of bilateral spermatic veins were measured.Both testises and kidneys were weighed.HE staining was used to observe pathological changes of penis and left testis.The success rate of modeling was calculated in the Model group.Results A VC and ED model was successfully established in 15 out of 20 rats in the Model group with a success rate of 75％.After modeling,the diameter of the left spermatic vein in the model group was increased significantly(P＜0.01)and was significantly larger than that before modeling(P＜0.01).The diameter of the right spermatic vein in the Model group was increased(P＜0.05)and higher(P＜0.05)than that before modeling.The weight of the left testis in the Model group was significantly decreased(P＜0.01)compared with that of the right testis.No significant difference in the bilateral kidney weights were observed between or within groups(P＜0.05).In the Model group,the numbers of erections,yawning,and genital grooming decreased significantly(P＜0.01)with the time of modeling.Pathological changes of the left testis and penis were significant in the Model group.Conclusions The Turner method increases the diameter of the spermatic vein in rats,causing testis injury and weight loss,and APO tests can be used to screen rats with ED after VC induction.The combination of the two method is suitable to establish an animal model of VC with an ED status similar to humans.

Objective:To investigate the status quo of nursing capacity for chronic respiratory disease in community health service centers.Methods:A questionnaire survey on nursing capacity for chronic respiratory disease was conducted in November 2018 among nurses working in internal medicine, general practice and chronic disease management departments of 4 community health service centers in Beijing Miyun District. The questionnaire included the knowledge and work content of chronic respiratory diseases. At the same time semi-structured interviews was conducted on the role of nurses in the management of chronic respiratory diseases among nurses selected by purposive sampling method.Results:In the study 63 valid questionnaires were collected and 14 nurses were interviewed. The results showed that the total score of nurses′ knowledge about chronic respiratory diseases was (62.0±14.4), and the scores of knowledge of chronic obstructive pulmonary disease (COPD), bronchial asthma and obstructive sleep apnea were (55.5±19.3), (61.0±21.6), (69.5±25.1), respectively. The total knowledge score of nurses with middle-rank professional title or above was higher than that of those with primary title [(67.0±12.9) vs. (54.0±13.6), t=-3.07, P<0.01]. The work contents mainly involved were nursing procedures(22/63,34.9%), health education(18/63,28.6%) and nursing evaluation(8/63,12.7%).Three themes were extracted from the deep interviews: the main work contents for nurses should be nursing procedures, nurses should participate in the chronic respiratory disease management as a member of the integrated medical team; nurses expected practice-oriented trainings of chronic respiratory disease management. Conclusions:The knowledge of chronic respiratory diseases among nurses in community health center needs to be improved, and the nursing skills special for respiratory diseases are needed. It is suggested to develop training courses and nursing guidelines suitable for community health centers and for nurses to participate in chronic respiratory disease management as team members, so that nurses in primary care institutions can play a better role in the management of chronic respiratory diseases.

Objective:To search, evaluate and summarize the evidence of the safety and application of closed tracheal suction systems and to provide reference for clinical nursing work.Methods:BMJ Best Practice, UpToDate, Joanna Briggs Institute Evidence-based Health Care Center, Guidelines International Network, National Institute for Health and Care Excellence, Scottish Intercollegiate Guidelines Network, Registered Nurses' Association of Ontario, American Assocition for Respiratory Care, Society of Critical Care Medicine, Medlive, Cochrane Library, PubMed, Embase, CINAHL, CNKI, Wanfang Database, China Biology Medicine disc were searched for related guidelines, system reviews, expert consensus, best practices, etc. The retrieval time was from the database construction to February 28, 2021. Two researchers independently evaluated the quality of the included literature and extracted and summarized the evidence of the literature that met the quality standards.Results:A total of 20 literatures were included, including 3 clinical decisions, 2 guidelines, 11 systematic reviews and 4 expert consensuses. A total of 27 pieces of best evidence were compiled from five aspects, including indications for use, clinical effects, safety, methods of use and replacement.Conclusions:This study summarizes the best evidence on the clinical application of closed sputum suction devices in adults. When applying the evidence, clinical nurses need to select the best evidence in combination with the clinical environment to standardize the clinical application of closed tracheal suction systems.

Objective:To introduce the usefulness and advantages of needle-type choledochotomy in laparoscopic common bile duct exploration.Methods:A retrospective analysis for the data of 1 107 patients who successfully implemented laparoscopic common bile duct exploration in Subei People′s Hospital of Jiangsu Province from January 1, 2013 to December 31, 2020 were applied. All cases were divided into the study group 662 cases with needle-type choledochotomy) and the control group (445 cases with non-needle-type choledochotomy) according to the manipulation of common bile duct incision. The time-cost, incidences of bleeding and bile leakage, as well as the recurrence rate of bile duct stone and the incidence of bile duct stenosis were observed and compared between the two groups. Normally distributed data were expressed as mean±standard deviation ( Mean± SD) and compared by t test while count data were expressed as frequency or percentage and compared by chi-square test or Fisher′s exact test. Results:The bile duct incision time and bleeding rate were (14.45±2.46) s and 25.1% in the study group, (104.48±15.32) s and 68.1% in the control group, respectively. The differences between the two groups were statistically significant ( P<0.001). The incidence of stone recurrence, biliary leakage, and bile duct stricture were 3.0%, 3.6% and 0.3% in the study group, 4.9%, 5.6% and 0.4% in the control group, respectively. There were no statistically significant differences between the two groups ( P>0.05). Conclusion:Needle-type bile duct incision can be used as a routine manipulation in laparoscopic common bile duct exploration for its time-saving, less bleeding, safe and easy to handling.

Objective:To study the Epstein-Barr virus (EBV) activity and its clinical characteristics in patients with hemorrhagic fever with renal syndrome (HFRS). Methods:From January 2016 to August 2017, patients with HFRS who were hospitalized in the First Affiliated Hospital of Harbin Medical University were routinely tested by EBV serology, and were divided into two groups according to their presence or absence of EBV infection, namely EBV active group and non-EBV active group. The clinical data between the two groups were compared and analyzed by SPSS 18.0.Results:A total of 188 HFRS patients were enrolled, including 73 cases in EBV active group and 115 cases in non-EBV active group. The EBV active rate of HFRS patients was 38.83% (73/188). The incidences of lumbago [57.53% (42/73) vs 42.61% (49/115)], abdominal pain [42.47% (31/73) vs 20.00% (23/115)], skin and mucosa congestion [57.53% (42/73) vs 39.13% (45/115)], and conjunctiva edema [50.68% (37/73) vs 28.70% (33/115)] in EBV active group were significantly higher than those in non-EBV active group (χ 2 = 3.983, 11.008, 6.083, 9.239, P < 0.05). There were 10, 7 and 43 patients with acute kidney injury (AKI) stage 1, 2 and 3 in EBV active group and 5, 13 and 53 patients in non-EBV active group. Degree of AKI in EBV active group was higher than that in non-EBV active group, and the difference was statistically significant (χ 2 = 12.615, P < 0.05). In EBV active group, the proportion of patients whose renal function recovery over 15 days [23.29% (17/73)] and white blood cell count [11.26 (3.39 ~ 54.23) × 10 9/L] were significantly higher than those in non-EBV active group [6.96% (8/115), 10.03 (2.91 ~ 66.99) × 10 9/L], and the differences were statistically significant (χ 2 = 10.330, Z = - 2.003, P < 0.05). Conclusion:HFRS patients may cause latent EBV activity, complicate their clinical features, cause severe renal damage and prolong the recovery time of renal function.

Objective:By building a patient safety oriented nursing-sensitive indicator system, this study aimed to help clinical evaluation and nursing for patients in prone position, to constantly optimize management of prone position and promote patient safety.Methods:First drew up initial indicators through literature search and personal interviews, then modified and finally formed the prone position nursing indicators within two rounds of experts consultation. Verified the indicators by evaluating nursing staff satisfaction after half-year′s implementation.Results:Finally, the indicator system included 9 first level, 13 second level and 71 third level indicators. The reliability of experts and the satisfaction of nurses were both high.Conclusions:With the purpose of patient safety, the nursing indicator system of prone position ventilation for critically ill patients are comprehensively covered ever aspect of key component. Specific effect needs to be further verified in the hospital management practice.

Objective:To explore risk factors of death in type A intramural hematoma (IMH) patients with conservative therapy and provide important information for clinical risks stratification and decisions-making.Methods:This retrospectively study enrolled 130 patients diagnosed with type A IMH in the first CT examination at Fuwai Hospital of Chinese Academy of Medical Sciences and only received conservative therapy between September 2009 and June 2018. Baseline clinical and CT characteristics were recorded. All patients enrolled were followed up. The endpoint was aortic disease-related death, patients were divided into endpoint group and non-endpoint group according to whether or not an endpoint event occurs. Difference between two groups of normally distributed continuous variables, non-normally distributed continuous variables and categorical variables were tested by independent sample t test, Mann-Whitney U test and chi-square test or Fisher′s exact test, respectively. Independent risk factors related to outcomes were assessed with Cox regression analysis and survival analysis. Results:In baseline CT data, the mean value of the maximum aortic diameter (MAD) was (49.2±6.9) mm, and the median value of the maximum hematoma thickness (MTH) was 11.0 (8.5, 13.2) mm. There were 56 and 30 patients with ulcer-like projection (ULP) and intramural blood pool (IBP), respectively, which including 36 patients with ULP of ascending aorta, 51 patients with pericardial effusion and 50 patients with pleural effusion. During a median follow-up time of 1 050 (242, 1 949) days, 26 patients experienced aortic disease-related death. Compared with non-endpoint group patients, patients who experienced aortic disease-related death showed older age and larger MAD( t=2.363, 3.640, P=0.020,<0.001), higher proportion of aortic atherosclerosis, ULP and pericardial effusion (χ 2=5.275, 6.596, 9.325, P=0.022, 0.010, 0.002).In Cox regression multivariate analysis shows that aortic atherosclerosis [hazard ratio (HR)=3.48, P=0.043], ULP (HR=2.66, P=0.019) and pericardial effusion (HR=2.49, P=0.030) were independent risk factors for aortic disease-related death. Conclusions:Aortic atherosclerosis, ULP and pericardial effusion are independent predictors of subsequent aortic disease-related death for type A IMH patients with conservative therapy, identifying these risk factors is helpful for further risk stratification and decisions-making.