Objective To explore the potential categories and influencing factors of fatigue trajectories in stroke patients,to provide information of the nursing management of patients with post-stroke fatigue after subsequent stroke.Methods 265 stroke patients hospitalized in the rehabilitation department of a tertiary A general hospital in Lishui from January 2022 to June 2023 were conveniently selected as the research subjects.The general information questionnaire,the Fatigue Severity Scale,the Health Behaviour Scale for Stroke Patient,and the Pittsburgh Sleep Quality Index were employed.The degree of fatigue was evaluated at 1～2 weeks,1 month,3 months and 6 months after the onset of the disease.The latent category growth model was used to identify the potential categories of fatigue trajectory,and logistic regression was used to analyze the influencing factors of fatigue trajectory.Results A total of 232 stroke patients were included,among which 128(55.17％)had fatigue,and there were 4 trajectories of fatigue,including 44 cases(18.97％)in the"continuous fatigue group",13 cases(5.60％)in the"increased fatigue group",71 cases(30.60％)in the"fatigue relief group",104 cases(44.83％)in the"no fatigue group".Logistic regression analysis showed that age,education level,health behavior and sleep quality were the influencing factors of fatigue trajectory in stroke patients(P＜0.05).Conclusion The fatigue of stroke patients can be divided into 4 kinds of change trajectories,and there is group heterogeneity.Nursing staff should carry out targeted nursing interventions for patients according to different fatigue change trajectories.

Objective To investigate the correlativity between elasticity modulus and pathological severity in chronic pancreatitis (CP).Methods Twenty-one pigs were divided randomly into experimental group (n=18) and control group (n=3) using random number method.The main pancreatic duct (MPD) was incompletely ligated to establish the CP model.In control group, MPD was not ligated.The animals were killed in batches at 4th, 8th and 12th week after surgery.The pancreatic tissue was taken for elasticity modulus test and pathological examination, and the pigs were classified into control, mild, moderate and severe groups based on the severity of fibrosis.Cell density, fat infiltration and extracellular edema were observed and classified into mild and severe.The difference of elasticity modulus among different groups were compared by Variance analysis, the correlation between pancreatic fibrosis and elastic modulus was analyzed with Spearman correlation analysis, and ROC curve was used to evaluate its efficacy of diagnosing CP.Results Sixteen CP models were established successfully expected for 2 deaths (mild, n=7;moderate, n=2 and severe, n=7).All of the control group (n=3) showed normal pancreas.The elasticity modulus of control, mild and moderate to severe group were 0.4268±0.0566, 0.3203±0.0518 and 0.2235±0.0685, respectively.The difference between the groups was statistically significant (F=13.658,P<0.01), and the elastic modulus and pathological grade had a negative correlation (r=0.969, P<0.01).AUC of elasticity modulus for differentiating normal and mild CP was 1.000, the best critical value was 0.3807, and both the sensitivity and specificity of the diagnosis were 100%.AUC for differentiating mild and moderate to severe CP was 0.8730, the best critical value was 0.2646, and the sensitivity and specificity of the diagnosis were 85.7% and 77.8%, respectively.The pancreatic elasticity modulus of low parenchymal cell density group and high parenchymal cell density group were 0.1931±0.0373 and 0.3485±0.0655, respectively, which in the high cell density group was significantly higher than that in the low cell density group (t=-5.719, P<0.01).The elasticity modulus of negative infiltration or slight fatty infiltration group and severe fatty infiltration group were 0.3401±0.0697 and 0.1855±0.0344, respectively, which in the negative infiltration or slight infiltration group was significantly higher than that in severe infiltration group (t=5.102, P<0.01).The elasticity modulus of negative or mild cell edema group and moderate to severe cell edema group were 0.2760±0.0825 and 0.3024±0.1056, respectively;there was no statistically significant(t=-0.586, P >0.05).Conclusions The elasticity modulus can be used to detect the pathological changes of CP, and evaluate the CP pathologic grades.

Objective To investigate the correlativity between secretin-stimulated magnetic resonance cholangiopancreatography (sMRCP) findings and pathological severity in a swine chronic
pancreatitis (CP) model. Methods Thirty-nine swine were divided randomly into control group (n=12) and experimental group (n= 27). In experimental group, the main pancreatic duct (MPD) was incompletely ligated to establish the model of obstructive CP. In control group, laparotomy was performed but without ligating the MPD. At the 4th, 8th and 12th week after modeling, one third swine of each group were undergone a series of dynamic sMRCP scans before (0 min) and at 1, 3, 5, 7, 9, 11 min after administration of secretin (0.6 μg/kg). And the MPD diameter and duodenum filling (DF) degree were measured. All survivals were sacrificed to pathological examination including HE and Van Gieson staining for histopathological grading. According to pathological severity, swine were divided into normal group, mild CP group and moderate to severe CP group. MRI features and indexes, including baselined diameter (BD), end diameter (ED), maximum diameter (MD), the largest expansion rate (LER), time to peak (Tpeak) and end change rate of pancreatic duct and duodenal filling (DF) scores were measured. The relationships between pathological grading and sMPCP indexes were analysed. The comparison of sMRCP data among the 3 groups were used ariance analysis, χ2 test and U test. Correlations between sMPCP indexes and pathological severity were tested using Spearman rank correlation coefficients. The diagnostic efficiency of sMRCP indexes were evaluated by ROC method. Results (1) In experimental group, 22 CP models were established and 19 CP swine (mild CP, n= 8; moderate and severe CP, n=11) were performed sMRCP successfully. Eleven swine in normal group were obtained satisfactory MRCP images. (2) sMRCP results:BD of 3 groups were (1.56 ± 0.46),(2.95 ± 1.17),(7.41 ± 1.91) mm, respectively. ED were (1.49 ± 0.31),(2.96 ± 1.17) and (7.37±1.90) mm, respectively. MD were (2.39±0.43),(3.91±1.27) and (7.86±1.87)mm, respectively. The median of LER were 42.10%, 34.85% and 6.58%, respectively. The median of DF scores were 3, 3, 2, respectively. The differences of above indexes have statistically significance (P values were all<0.01). There were correlation between sMRCP indexes (BD, ED, MD, LER and DFscores) and pathological severity (r values were 0.89, 0.92, 0.90,-0.85,-0.66, respectively and P values were all<0.01). Tpeak and end change rate of pancreatic duct had no significant differences (P values were>0.05),and no correlation with pathological severity(P values were all>0.05).For differential diagnosis between normal and mild CP, the area under ROC of BD, ED, MD, LER and DFscores were 0.915, 0.977, 0.926, 0.778 and 0.472, respectively and differential diagnosis between mild CP and moderate to severe CP group, the area under ROC were 0.966,0.966,0.960,1.000 and 0.915, respectively. Conclusions sMRCP findings of CP have characteristics and could be used for in vivo evaluation on the CP pathologic grades.

Objective To evaluate 99mTc-ciprofloxacin (Infecton) scintigraphy as a method for detecting secondary infections associated with ANP in swine,in comparison with CT.MethodsTwenty-eight healthy swine were randomly assigned to control group (n =6),non-infected ANP (n =6) and infected ANP group( n =16).ANP model was induced by retrograde injection of sodium taurocholate and pancreatic protease mixture into the biliary and pancreatic duct.Two days after ANP induction,swine in infected ANP group were injected with 3 x 108 E.coli into pancreatic tissue,while swine in non-infected ANP group were injected with inactivated E.coli.At 7 d after inoculation,at 0.5,1,2,3,4,and 6 h after intravenous administration of 370 MBq of Infecton,SPECT scan was performed.Then 64-slice spiral CT scan was performed.Then swine were sacrificed,and histopathology examination and bacterial culture of pancreatic tissue were performed.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of the two methods to detect secondary infections were determined.ResultsThere were no abnormality in the normal pancreas and the bacterial culture was negative.There were pancreatic necrosis in the non-infected ANP group,but the bacterial culture was negative.There were pancreatic necrosis and infection in the infected ANP group and the bacterial culture was positive.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of the Infecton method were 93.8％ ( 15/16 ),91.7％ ( 11/12 ),92.9％ ( 26/28 ),93.8 ％(15/16) and 91.7％ ( 11/12),whereas these values for CT were 12.5％ (2/16),100.0％ ( 12/12),50.0％(14/28),100.0％ (2/2) and 46.2％ (12/26),respectively.The sensitivity,accuracy,and negative predictive value of the Infecton method were significantly higher than those in CT group (P ＜0.01 ).ConclusionsInfecton scintigraphy may be a better procedure for detecting ANP secondary infections than CT.