Objective:To retrospectively analyze clinical characteristics and treatment of pemphigus/bullous pemphigoid (BP) complicated by herpes simplex virus (HSV) infection.Methods:Inpatients with pemphigus/BP complicated by HSV infection were collected from Wuhan No.1 Hospital from 2016 to 2021, and their clinical characteristics, treatment and follow-up results were retrospectively analyzed.Results:Among the 8 patients with pemphigus/BP complicated by HSV infection, there were 2 males and 6 females, and their age was 50.6 ± 8.3 years. Five of them were diagnosed with pemphigus vulgaris (PV), 1 with pemphigus foliaceus (PF), and 2 with BP. Seven were infected with HSV-1, and 1 with HSV-2. All the 8 patients were given systemic glucocorticoids and immunosuppressive agents for the treatment of pemphigus or BP, and were admitted to the hospital due to resistance to the treatment. Seven patients presented with exacerbation or recurrence of primary lesions, and 1 presented with enlarged lesions all over the body. HSV infection-induced lesions were located on the trunk in 4 cases, on the oral mucosa in 4, on the scalp in 3, and on the face in 2; lesions mainly manifested as irregular erosions with blood crusts, and some centrally umbilicated pustules; 7 patients had obvious pain at the lesional sites. During HSV infection, anti-desmoglein 1 antibody levels decreased in all the 6 patients with pemphigus, and anti-desmoglein 3 antibody levels decreased in 4 of the 5 patients with pemphigus vulgaris; anti-BP180 antibody levels decreased in 1 patient with BP, but increased in the other one with BP. After antiviral therapy at adequate doses for adequate durations (7- to 14-day treatment with valacyclovir alone or in combination with ganciclovir), HSV infection was controlled, the autoimmune bullous skin disorder intensity scores decreased compared with those before the antiviral therapy, and pain was significantly relieved in all the patients. No dose adjustment of glucocorticoids or other immunosuppressive agents was made during antiviral therapy in all patients.Conclusion:HSV infection should be considered when patients with pemphigus/BP suffer from recurrence or exacerbation and poorly respond to conventional treatment; for patients with pemphigus/BP complicated by HSV infection, systemic antiviral therapy at adequate doses can be used to control the disease condition without modifying the conventional immunosuppressive regimen.

Patients with heart failure have a high burden of symptoms, poor quality of life and poor long-term prognosis. Palliative care can improve symptoms, quality of life and health outcomes in patients with heart failure. In order to provide timely palliative care, identifying the palliative care needs of patients with heart failure is key to their care. This article reviews the admission recognition tools for palliative medical care for heart failure patients, with the aim of providing reference for the development and application of admission recognition tools for palliative medical care for heart failure patients in China.

Objective: To comb the development of transitional care, analyze and compare the research hotspots and frontiers at home and abroad. Methods: CNKI Database and Web of Science Core Collection were taken as data sources to retrieve the relevant literature published from 2000 to 2019; CiteSpace software was used to construct scientific knowledge maps for visualization analysis. Results: A total of 285 Chinese and 1 179 English documents were retrieved, and the annual publications showed an upward trend from 2012. The high-yield institutions and authors were relatively scattered. Chinese papers focused on subjective indicators such as quality of life, and most of which were literature review. While English papers tended to focus on objective indicators, such as readmission and mortality rate, and the research type was mainly intervention study. The Chinese keywords "WeChat" and English "palliative care" were with the strongest citation bursts in recent years. Conclusions The domestic development of transitional care is relatively lagging; cooperation between institutions and authors should be strengthened. Future researches on palliative care or combined with WeChat platform may become hotspots in this field.

Objective:To explore the research hotspots of flipped classroom in nursing education at home and abroad so as to provide a reference for nursing educators to further develop the flipped classroom in China.Methods:Visual analysis was carried out for literatures related to application of flipped classroom in nursing education retrieved in the Chinese National Knowledge Infrastructure (CNKI) and WanFang Data from 2015 to 2019, and in Web of Science core collection from 2013 to 2019 with the CiteSpace.Results:Totals of 135 Chinese literatures and 114 English literatures were screened. The number of published papers showed an increasing trend year by year. Chinese literatures key words had a low level of network density, and researchers were relative decentralization.Conclusions:Chinese literatures researches focused on practice. We should strengthen the theoretical model research and the localization exploration to promote the in-depth development of flipped classroom in nursing education.

Objective: To explore the feasibility of real-time three-dimensional ultrasound Xplane imaging in quantifying left and right atrial diastolic maximal volume (LAVmax, RAVmax) and evaluating cardiac diastolic function in fetuses with cardiac disease in second and later trimesters. Methods: One hundred and forty-four fetuses with abnormal heart morphology at 16-34 weeks of gestational age were included and divided into 3 groups according to the influence of pathological changes on atrial volume: group A with symmetrical left and right atrial volume, group B with decreased left atrial volume and increased right atrial volume and group C with increased left atrial volume and decreased right atrial volume, and the fetus were also divided into 2 groups according to the law of fetal development: the middle pregnancy group (16-27^{+ 6} weeks) and the late pregnancy group (28-34^{+ 6} weeks). Using the " Xplane" mode of volume probe, the maximal atrial volume was calculated automatically by tracing method and three-path line method. The correlation between the two methods in quantitative LAVmax was validated by paired sample t test and Pearson correlation analysis. The correlation between LAVmax, RAVmax and gestational age were analyzed by curve fitting. The volumes of bilateral chambers and the average weekly growth rates of E peak, A peak and E/A value of mitral and tricuspid orifices were calculated and compared. Results: There was no significant statistical difference between the maximal volume of the left atrium obtained by the tracing method and the three-diameter line method (P>0.05), and there was high correlation between the two methods in the comparison of the maximal volume of the left atrium (r=0.90, 0.88, 0.85; all P<0.01). The data of group A, B and C showed that LAVmax and RAVmax could increase with the increase of gestational weeks in a certain period of abnormal state, and had a good correlation with them(LAVmax: r=0.78, 0.74, 0.78, all P<0.005; RAVmax: r=0.79, 0.77, 0.78, all P<0.005). The average weekly growth rate of RAVmax showed an advantage in group A, B and C. Especially in group C with reduced right atrium, the growth rate of right atrium was 8.15%, which was higher than that of group B with decreased left atrium by 5.06%. The weekly growth rates of E peak and E/A in tricuspid orifice were also higher than those in mitral orifice. The E peak and E/A values of tricuspid orifice in group C were 4.05% and 0.60%, respectively, higher than those in group B, which were 2.58% and 0.02%. Peak A showed an increase in growth rate in group B and group C with decreased atria, peak A values in group B and group C increased by 4.01% and 2.19%, respectively. Conclusions The right ventricular dominance of fetal heart can still be reflected in certain stages of disease, and the atrial active systolic may play a regulatory role in the filling of cardiac blood flow. Real-time three-dimensional ultrasound Xplane imaging could be used to quantify the atrial volume of fetuses with abnormal heart morphology in second and later trimesters and to preliminary assess atrial function combined with the changes of atrioventricular valve orifice hemodynamics. Real-time three-dimensional ultrasound Xplane imaging technology has obvious advantages of simple, safe, non-invasive, simultaneous and high repeatability in measuring fetal atrial volume.

ObjectiveTo investigate the quality of life in patients with severe aortic stenosis (AS) after transcatheter aortic valve replacement (TAVR) and analyze the related influencing factors. MethodsA total of 139 patients who had undergone TAVR in Department of Cardiovascular Medicine, West China Hospital, Sichuan University, were selected through the hospital electronic medical record system from April of 2012 to April of 2017. By using the General Information Questionnaire for Patients, Charlson＇s co-morbidity Index (CCI), Morisky Medication Adherence Scale, and China Cardiovascular Quality of Life Questionnaire (CQQC), their life quality were investigated and the influencing factors were analyzed. ResultsThe average score of CQQC after TAVR was (78.76±16.52), lower than the national norm. There were statistical difference in the scores of CQQC in patients with different ages, marital status, educational background, cardiac function preoperation, CCI weight, smoking status, drinking status, and regular exercise status(P＜ 0.05). Stepwise regression analysis indicated that, age,marital status, cardiac function preoperation, time of length postoperation and regular exercise could be included into the regression modal, accounting for 34.9% of variances. ConclusionsThe quality of life of patients after TAVR is low. Age, marital status, preoperative cardiac function, postoperative time and regular exercise will affect the quality of life of patients. It is suggested that medical staff should pay attention to the quality of life of TAVR patients after operation and carry out targeted nursing intervention and health education actively, as well as scientific rehabilitation exercise so as to improve the quality of life of TAVR patients after operation.

Objectives To explore the effect of case analysis method in clinical nursing practice teaching of cardiology diseases.Methods 48 nursing undergraduates in cardiology department from July 2015 to May 2017 were selected into experimental group and 50 nursing undergraduates from July 2013 to June 2015 in cardiology department were retrospectively divided into control group.The control group adopted small lectures to explain the nursing assessment,diagnosis and nursing measures to the students.In experimental group,case analysis method was applied into nursing practice teaching,which concluded guiding group students to choose common kinds of typical cases firstly,collecting the patient's information,reviewing nursing assessment,diagnosis and intervention of the selected disease,and finally comparing cases with theoretical knowledge.After that,group students should apply case analysis method to clinical nursing practice under the guidance of teachers.Finally,academic performance,overall nursing assessment,and acceptance of the case analysis method in the above two groups were compared.Results The results of experimental group in academic performance [(81.70 ± 3.22) vs.(75.63 ± 3.01)] and in overall nursing examination [(91.93 ± 3.07) vs.(84.27 ± 3.08)] were significantly superior to control group.Meanwhile,the experimental group students showed higher acceptance of case analysis method.Conclusion Case analysis method can help nursing undergraduates to combine theoretical knowledge and clinical practice better,make deeper understanding of theoretical knowledge,apply it in clinical practice neatly,and improve students' ability of critical thinking.

Objective To investigate the effects of tumor necrosis factor-related ligand-1A(TL1A)on activation of T helper 9(Th9)cells of colonic tissues in chronic experimental colitis mice.Methods The chronic experimental colitis mice model was established with drinking dextran sulfate sodium salt(DSS).A total of 32 lymphocytes TL1A highly expressed mice and wild type(WT)mice were divided into WT control group, transgene control group,WT modeling group and transgene modeling group.The mice of control groups were administrated with distilled water. The mice of modeling groups received 3% DSS in drinking water discontinuously.The mice were sacrificed on 29 days after modeling.Body mass was measured,length of colon was recorded,scores of gross colon and the disease activity index(DAI)were calculated.The colonic morphological changes were observed by hematoxylin-eosin(H-E)staining.The lamina propria mononuclear cells(LPMC)were isolated and the number of Th9 cells was tested by flow cytometry.The levels of interleukin-9(IL-9)in serum and LPMC were detected by enzyme-linked immunosorbent assay(ELISA).The expressions of IL-9 protein and mRNA of the colonic tissues were measured by Western blotting and real-time polymerase chain reaction(PCR),respectively.T test and single factor analysis of variance were performed for statistical analysis.Results The percentage of body mass loss of WT modeling group was lower than that of transgene modeling group(16.2% ± 1.0% vs 18.9% ± 1.2%),and the difference was statistically significant(t=4.90, P<0.05).The scores of gross colon,DAI and pathology of transgene modeling group were all higher than those of WT modeling group(2.80 ± 0.64 vs 1.60 ± 0.31,2.55 ± 0.20 vs 1.58 ± 0.17,and 11.85 ± 0.86 vs 9.50 ± 0.79),and the differences were statistically significant(t=4.77,10.45 and 5.69,all P<0.05).The number of LPMC in transgene modeling group was higher than that of WT modeling group(3.70×106± 0.28×106vs 2.65×106± 0.32 × 106)and the difference was statistically significant(t= 6.98,P< 0.05).The percentage of Th9 in total CD4+T cells of LPMC in colonic tissues of transgene modeling group was higher than that of WT modeling group(0.54% ± 0.04% vs 0.23% ± 0.03%),and the difference was statistically significant(t= 17.54,P< 0.05).The serum IL-9 level of transgene modeling group was higher than that of WT modeling group((170.23 ± 5.69)pg/mL vs(150.62 ± 6.45)pg/mL),and the difference was statistically significant(t= 6.50,P< 0.05).The level of IL-9 secreted by LMPC of transgene modeling group was higher than that of WT modeling group((265.21 ± 8.76)pg/mL vs (237.58 ± 10.24)pg/mL),and the difference was statistically significant(t= 5.80,P< 0.05).The expressions of IL-9 protein and mRNA of transgene modeling group were higher than those of WT modeling group(1.31 ± 0.09 vs 1.18 ± 0.03,and 8.26 ± 1.13 vs 2.25 ± 0.29,respectively),and the differences were statistically significant(t=3.88 and 14.57,both P< 0.05).Conclusion TL1A high expression in lymphocytes can promote Th9 cells differentiation and IL-9 secretion which involved in the genesis of chronic experimental colitis.

Objective To observe the clinical efficacy of thermal electroacupuncture therapy in treating lumbodorsal myofascitis. Method Sixty-two patients with lumbodorsal myofascitis were randomized into a treatment group of 30 cases and a control group of 32 cases. The treatment group was intervened by thermal electroacupuncture therapy, while the control group was by orally taking Meloxicam tablets. The Visual Analogue Scale (VAS) was observed before and after treatment, and the clinical efficacies were compared.Result The total effective rate was 100.0% in the treatment group versus 78.1% in the control group, and the difference was statistically significant (P<0.05). The VAS scores were significantly changed after treatment in both groups (P<0.05). After treatment, the VAS score in the treatment group was significantly different from that in the control group (P<0.05).Conclusion Thermal electroacupuncture therapy is an effective approach in treating lumbodorsal myofascitis.

Objective To investigate risk factors for feeding intolerance of preterm infants under the reactive scope model guidance, and provided empirical evidence for effective prevention and treatment of feeding intolerance in preterm infants. Methods Checked the cases of 242 preterm infants been treated in the neonatal department from August 2014 to January 2015 according to the order of admission. Through literature reviewing and expert consultation, the clinical observation table was designed based on the reactive scope model, and risk factors for feeding intolerance of preterm infants were investigated by single factor analysis and logistic regression analysis from the feeding intolerance (FI) group and non-FI group. Results The incidence of feeding intolerance in preterm infants was 33.8%(70/207), feeding intolerance in preterm infants often occurred during the period of being fed within 72 hours, and the clinical manifestations were gastric retention, abdominal distension and emesis. Single factor analysis showed that gestational age, birth weight, fetal distress, aminophylline application, intrauterine infection, breast milk feeding and twice stool interval were the related factors to the feeding intolerance. Logistic regression analysis showed that gestational age and birth weight were the protective factors of FI. Fetal distress, aminophylline application, twice stool interval >3 d were the risk factors of FI. Conclusions Gestational age and birth weight were the protective factors of FI. Fetal distress, aminophylline application, twice stool interval>3 d were the risk factors of FI.