Objective:To construct an evaluation index system for clinical practice effectiveness of undergraduate nursing students, so as to provide a basis for the evaluation of clinical practice effectiveness of undergraduate nursing students.Methods:Based on the improved Miller's pyramid theory, a preliminary evaluation index system for clinical practice effectiveness of nursing undergraduate students was formed by literature analysis and semi-structured interview method. From April to July 2023, purposive sampling was used to select 20 experts in nursing education, clinical nursing teaching, and other fields. After two rounds of Delphi expert consultation, a final evaluation index system for clinical practice effectiveness of undergraduate nursing students was formed, and the weights of each index were determined.Results:After two rounds of consultation, the effective response rates of the questionnaire were 95.00% (19/20) and 100.00% (19/19), respectively. The expert authority coefficients were 0.86 and 0.88, and the Kendall harmony coefficients were 0.226 and 0.183 ( P<0.01). The final established evaluation index system for clinical practice effectiveness of undergraduate nursing students included five primary indicators, 13 secondary indicators, and 56 tertiary indicators. Conclusions:Based on the improved Miller's pyramid theory, the evaluation index system for clinical practice effectiveness of undergraduate nursing students constructed is scientific, reliable, and practical, which can provide reference for the evaluation of clinical practice for undergraduate nursing students.

Objective To construct home-based rehabilitation nursing program for elderly patients with chronic obstructive pulmonary disease based on functional physical fitness index. Methods Through literature search, case review and the daily needs, disease characteristics, physical fitness and other core indicators of elderly patients with chronic obstructive pulmonary disease, the first draft of home rehabilitation nursing program for elderly patients with chronic obstructive pulmonary disease was constructed. The expert consultation questionnaire was prepared, and 12 experts related to respiratory and rehabilitation were selected through group discussion, and two rounds of expert consultation were conducted. Results The recovery rate of the two rounds of expert consultation questionnaires was 83.3 % for both rounds, with an expert authority coefficient of 0.90. The home-based rehabilitation nursing program consists of four primary indicators, eleven secondary indicators, and thirty-three tertiary indicators. Conclusion The home-based rehabilitation nursing program for elderly patients with chronic obstructive pulmonary disease constructed based on functional physical fitness is feasible, scientific and innovative, which can provide theoretical basis for clinical application.

Colorectal cancer （CRC）， as the third most common cancer in the world， develops from the colonic and rectal epithelial cells. With the rapid development of the global economy， the incidence of CRC in developing countries has been increasing year by year. In the past few years， although preventive colonoscopy screening has improved the survival rate of CRC patients， the majority of cases are still detected after symptoms appear. Currently， the clinical treatment of CRC carries high surgical risks and is prone to recurrence， while radiotherapy and chemotherapy have significant side effects and cause a heavy psychological burden on patients. Therefore， there is currently no ideal treatment protocol for CRC. The phosphatidylinositol 3-kinase/protein kinase B （PI3K/Akt） pathway， as a classical oncogenic pathway， provides potential for the diagnosis and treatment of various malignant diseases， and offers a new direction for the treatment of CRC. In recent years， traditional Chinese medicine （TCM） has become a major focus in cancer treatment due to its advantages in "preventing and treating diseases" and its multiple components， targets， and pathways. Its advantages in having fewer side effect complement western medicine in treatment. Multiple studies have shown that Chinese medicinal monomers and compound formulas can inhibit the proliferation， invasion， migration， and angiogenesis of CRC cells， promote apoptosis and autophagy of cancer cells， and slow down the development of CRC by intervening in the PI3K/Akt signaling pathway， thereby achieving the therapeutic effect on CRC. In recent years， the research progress related to this has been updating rapidly. Previous literature failed to timely incorporate the latest research results， which brought many inconveniences to the literature search of many scholars. Therefore， this article summarized the relevant information from PI3K/Akt pathway， the association between the PI3K/Akt pathway and CRC， and the progress of TCM intervention in the treatment of CRC to provide references for the development of CRC in molecular biology and the clinical development of new drugs in the future.

ObjectiveTo investigate the characteristics of traditional Chinese medicine syndrome and the evolution of pathogenesis in different stages of atherosclerotic thrombotic cerebral infarction （ATCI）. MethodsClinical data of 3088 ATCI patients from 8 hospitals in 6 provinces and cities were collected from the hospital information system during January 1， 2015 to December 31， 2019. After staging and counting clinical symptoms， common factors were extracted using the principal component analysis method in factor analysis. Cluster analysis was then carried out on the basis of the factor analysis. The results of the combination of the evidence element identification， cluster analysis and expert discussion were used to discuss the evidence of the different disease stages of atherosclerotic cerebral infarction. ResultsOf the 3088 ATCI patients included， 2290 cases were in the acute phase and 798 in the non-acute phase. Excluding the main symptoms of ischaemic stroke， such as numbness and weakness of limbs， unfavourable movement， unfavourable speech and dizziness， we identified 84 indicators with a frequency ≥5% of the four diagnostic information variables. Of these， 36 indicators were observed in the acute phase and 35 in the non-acute phase. Factor analysis extracted 14 common factors from each phase. We selected factors with a loading coefficient ＞0.3 for evidence determination. These 14 groups of common factors were used as variables for clustering. After clustering， the acute， non-acute phase were each divided into 5 categories. Based on a combination of clinical practice and expert opinion， the symptoms identified in the acute period were syndrome of deficiency of both qi and yin， syndrome of blockade of wind-phlegm-static blood （36.07%）， syndrome of qi deficiency and blood stasis （20.74%）， syndrome of upward disturbance of wind-fire （15.15%）， syndrome of stirring wind due to yin deficiency （9.43%）， and syndrome of spleen deficiency and liver hyperactivity （3.80%）. In the non-acute phase， the symptoms were qi and yin deficiency with syndrome of qi stagnation and blood stasis （45.49%）， syndrome of deficiency of both qi and yin （20.05%）， syndrome of qi stagnation and blood stasis （16.42%）， spleen-kidney deficiency syndrome （8.52%）， and syndrome of hyperactivity of liver yang （4.89%）. ConclusionThe acute phase of AICI is mainly characterized by blood stasis， fire， internal wind， hyperactivity of yang， qi deficiency and yin deficiency， while the non-acute phase is characterized by yin deficiency， qi deficiency， blood stasis and qi stagnation. The main pathomechanism of ATCI involves deficiency of qi and yin， as well as obstruction of the channels by phlegm and blood stasis， and the fundamental pathomechanism is deficiency of qi and yin.

Ischemic stroke(IS)is a multifactorial and heterogeneous disease.Despite years of studies,effective strategies for the diagnosis,management and treatment of stroke are still lacking in clinical practice.Metabolomics is a growing field in systems biology.It is starting to show promise in the identification of biomarkers and in the use of pharmacometabolomics to help patients with certain disorders choose their course of treatment.The development of metabolomics has enabled further and more biological appli-cations.Particularly,metabolomics is increasingly being used to diagnose diseases,discover new drug targets,elucidate mechanisms,and monitor therapeutic outcomes and its potential effect on precision medicine.In this review,we reviewed some recent advances in the study of metabolomics as well as how metabolomics might be used to identify novel biomarkers and understand the mechanisms of IS.Then,the use of metabolomics approaches to investigate the molecular processes and active ingredients of Chinese herbal formulations with anti-IS capabilities is summarized.We finally summarized recent developments in single cell metabolomics for exploring the metabolic profiles of single cells.Although the field is relatively young,the development of single cell metabolomics promises to provide a powerful tool for unraveling the pathogenesis of IS.

Background::High-dose dual therapy (HDDT) with proton pump inhibitors (PPIs) and amoxicillin has attracted widespread attention due to its favorable efficacy in eradicating Helicobacter pylori ( H. pylori). This study aimed to compare the efficacy and safety of high-dose PPI–amoxicillin dual therapy and bismuth-containing quadruple therapy for H. pylori rescue treatment. Methods::This was a prospective, randomized, multicenter, non-inferiority trial. Patients recruited from eight centers who had failed previous treatment were randomly (1:1) allocated to two eradication groups: HDDT (esomeprazole 40 mg and amoxicillin 1000 mg three times daily; the HDDT group) and bismuth-containing quadruple therapy (esomeprazole 40 mg, bismuth potassium citrate 220 mg, and furazolidone 100 mg twice daily, combined with tetracycline 500 mg three times daily; the tetracycline, furazolidone, esomeprazole, and bismuth [TFEB] group) for 14 days. The primary endpoint was the H. pylori eradication rate. The secondary endpoints were adverse effects, symptom improvement rates, and patient compliance. Results::A total of 658 patients who met the criteria were enrolled in this study. The HDDT group achieved eradication rates of 75.4% (248/329), 81.0% (248/306), and 81.3% (248/305) asdetermined by the intention-to-treat (ITT), modified intention-to-treat (MITT), and per-protocol (PP) analyses, respectively. The eradication rates were similar to those in the TFEB group: 78.1% (257/329), 84.2% (257/305), and 85.1% (257/302). The lower 95% confidence interval boundary (–9.19% in the ITT analysis, –9.21% in the MITT analysis, and –9.73% in the PP analysis) was greater than the predefined non-inferiority margin of –10%, establishing a non-inferiority of the HDDT group vs. the TFEB group. The incidence of adverse events in the HDDT group was significantly lower than that in the TFEB group (11.1% vs. 26.8%, P < 0.001). Symptom improvement rates and patients’ compliance were similar between the two groups. Conclusions::Fourteen-day HDDT is non-inferior to bismuth-containing quadruple therapy, with fewer adverse effects and good treatment compliance, suggesting HDDT as an alternative for H. pylori rescue treatment in the local region. Trial registration::Clinicaltrials.gov, NCT04678492.

Objective:To translate Career Success in Nursing Scale (CSNS) into Chinese and evaluate the reliability and validity of it.Methods:According to the translation principle of Brislin questionnaire, the English version of CSNS was translated, back-translated and culturally adjusted to determine the simplified Chinese version of CSNS items and form the Chinese version of CSNS. A total of 1 489 nurses from China-Japan Friendship Hospital were selected as the research objects from May to June 2021. The general information questionnaire and simplified Chinese version of CSNS were used to investigate them. Internal consistency and split-half reliability coefficient were used to evaluate the reliability of the scale. Pearson correlation analysis was used to analyze the correlation between each dimension and the relationship between each dimension and the total scale. A total of 1 489 questionnaires were collected and 1 434 valid questionnaires were collected, with an effective recovery rate of 96.3%.Results:The Chinese version of CSNS included 4 dimensions, such as "desired career development" "providing quality care" "effective self-regulation" and "fit between human and organization" , with a total of 39 items. The expert content validity was 0.984. The results of exploratory factor analysis showed that the cumulative variance contribution rate of the four common factors was 74.71%. The Cronbach's α coefficient of the total scale was 0.985 and the Cronbach's α coefficient of each dimension was 0.955-0.979. The split-half reliability of the total scale was 0.986 and the split-half reliability of each dimension was 0.957-0.979. The test-retest reliability of the scale was 0.966.Conclusions:The Chinese version of CSNS scale has good reliability and validity, which can be used to evaluate the psychological characteristics of nurses' career success.

Cardio-cerebrovascular disease (CCVD) is a major comorbidity of Coronavirus disease 2019 (COVID-19). However, the clinical characteristics and outcomes remain unclear. In this study, 102 cases of COVID-19 from January 22, 2020 to March 26, 2020 in Xixi Hospital of Hangzhou were included. Twenty cases had pre-existing CCVD. Results showed that compared with non-CCVD patients, those with CCVD are more likely to develop severe disease (15% versus 1%), and the proportion of pneumonia severity index grade IV was significantly higher (25% versus 3.6%). Computed tomography images demonstrated that the proportion of multiple lobe lesion involvement was significantly higher in the CCVD group than in the non-CCVD group (90% versus 63.4%). Compared with non-CCVD group, the levels of C-reactive protein, fibrinogen, D-dimer, and serum amyloid-A were higher, whereas the total protein and arterial partial PaO
COVID-19 ; Cerebrovascular Disorders/epidemiology* ; Comorbidity ; Humans ; SARS-CoV-2 ; Tomography, X-Ray Computed

Objective:To construct a clinical practice curriculum system for respiratory specialist nurses based on core competence.Methods:Based on the theoretical basis of the core competence of respiratory specialist nurses, an item pool of the clinical practice curriculum system for respiratory specialist nurses was initially formed through literature review, brainstorming, and semi-structured interviews. From October to November 2020, the Delphi method was used to conduct two rounds of correspondence inquiries to 20 nursing and medical experts from the respiratory field, and finally the framework and content of the clinical practice curriculum system for respiratory specialist nurses were determined.Results:The effective recovery rates of the 2 rounds of expert questionnaires were 100.00% and 95.00%, respectively; expert authority coefficients were 0.88 and 0.90, respectively; Kendall's W coefficients were 0.232 and 0.302, respectively ( P<0.01) ; the finally established clinical practice curriculum system for respiratory specialist nurses included 4 primary items, 14 secondary items, and 68 tertiary items. Conclusions:The clinical practice curriculum system for respiratory specialist nurses is highly scientific and practical, which can be applied to clinical practice teaching for respiratory specialist nurses.

Objective? To explore the risk factors of severe influenza A H1N1 by the Meta-analysis so as to provide a reference for prevention and control. Methods? Literatures on risk factors of severe influenza A H1N1 were retrieved in Chinese Biomedical Medicine, China national knowledge internet (CNKI), Wanfang Database, VIP Database, PubMed and ProQuest from 1st January 2000 to 31st December 2018 by computer. Quality of literatures were evaluated with the Newcastle-Ottawa Scale (NOS) on standard quality evaluation. Heterogeneity test of literatures was analyzed with the RevMan 5.1, and the odds ratio (OR) and 95% confidence interval (CI) was calculated with the Meta-analysis. Results? A total of 10 literatures were included. Among those literatures, there were 1 852 cases in case group, 3 049 cases in control group and 8 risk factors. Meta-analysis showed that the risk factors of severe influenza A H1N1 included ages ≤5 years (OR=6.09, 95%CI: 1.77-21.16), pregnancy (OR=11.80, 95%CI: 6.91-20.16), chronic underlying disease (OR=3.74, 95%CI: 2.34-5.97), BMI≥ 30 kg/m2 (OR=4.48, 95%CI: 2.81-7.12), time between attack and seeking medical advice≥ 48 h (OR=1.85, 95%CI: 1.50-2.28) and infected with HIV (OR=1.74, 95%CI: 1.33-2.27) with statistical differences (P＜0.001). Influenza vaccination which was a protective factor had a negative influence on incidence of severe influenza A H1N1 (OR=0.63, 95%CI: 0.49-0.82). Conclusions? Risk factors of severe influenza A H1N1 comprise ages≤ 5 years, pregnancy, chronic underlying disease, BMI≥ 30 kg/m2, time between attack and seeking medical advice≥ 48 h and infected with HIV, and influenza vaccination is a protective factor. Influenza vaccination can effectively reduce the incidence of severe influenza A H1N1 or slow down the disease progression. Evidence on gender as a risk factor of severe influenza A H1N1 is insufficient which needs to be tested by later researches.