Objective:To review the clinical status based on the best evidence of drug administration in patients with dysphagia, systematically analyze the obstacle factors and promoting factors in the process of evidence transformation, and formulate reform strategies.Methods:Based on the evidence-based nursing research method and the guidance of the Ottawa Model of Research Use (OMRU), the review indicators were developed based on the best evidence. The current status of clinical practice behaviors of 223 patients and 75 nurses in the Neurology, Neurosurgery and Geriatric departments of the Affiliated Hospital of Jiangsu University were reviewed from July to December 2021.Based on the results of the review, qualitative interviews were conducted with 32 potential adopters, and content analysis was used to assess the barriers and contributing factors to the clinical translation of evidence in three aspects: evidence-based change, potential adopters and practice environment, so as to develop effective strategies.Results:Based on the 22 best evidence selected, the evidence-based team developed 25 review indicators to carry out clinical review, showing that the compliance rate of 16 indicators were less than 60%. By analyzing and summarizing the interview results of potential adopters, the main obstacles leading to the low compliance rate of nurses were analyzed as follows: evidence-based reform changed the traditional work mode, and the application of evidence was not convenient; at the level of potential adopters, nurses had poor knowledge and practice, heavy work burden, and low awareness of patients and caregivers; at the level of practice environment, there was lack of nursing norms and procedures for clinical transformation of evidence, and the channels of multi-disciplinary collaboration and communication were not smooth. The main promoting factors were the perfect supervision mechanism of evidence-based nursing projects, the evidence-based group had rich experience in evidence transformation, the management was willing to change, and the practitioners were good at innovation.Conclusions:There is still a large gap between the clinical practice and the best evidence of drug administration in patients with dysphagia. The promoting factors should be fully utilized to overcome the obstacles and implement improvements to promote the effective transformation of evidence into clinical practice.

BACKGROUND: The effect of arteriosclerotic intracranial arterial vessel wall enhancement (IAVWE) on downstream collateral flow found in vessel wall imaging (VWI) is not clear. Regardless of the mechanism underlying IAVWE on VWI, damage to the patient's nervous system caused by IAVWE is likely achieved by affecting downstream cerebral blood flow. The present study aimed to investigate the effect of arteriosclerotic IAVWE on downstream collateral flow. METHODS: The present study recruited 63 consecutive patients at the Second Hospital of Hebei Medical University from January 2021 to November 2021 with underlying atherosclerotic diseases and unilateral middle cerebral artery (MCA) M1-segment stenosis who underwent an magnetic resonance scan within 3 days of symptom onset. The patients were divided into 4 groups according to IAVWE and the stenosis ratio (Group 1, n = 17; Group 2, n = 19; Group 3, n = 13; Group 4, n = 14), and downstream collateral flow was analyzed using three-dimensional pseudocontinuous arterial spin labeling (3D-pCASL) and RAPID software. The National Institutes of Health Stroke Scale (NIHSS) scores of the patients were also recorded. Two-factor multivariate analysis of variance using Pillai's trace was used as the main statistical method. RESULTS: No statistically significant difference was found in baseline demographic characteristics among the groups. IAVWE, but not the stenosis ratio, had a statistically significant significance on the late-arriving retrograde flow proportion (LARFP), hypoperfusion intensity ratio (HIR), and NIHSS scores ( F = 20.941, P <0.001, Pillai's trace statistic = 0.567). The between-subject effects test showed that IAVWE had a significant effect on the three dependent variables: LARFP ( R2 = 0.088, F = 10.899, P = 0.002), HIR ( R2 = 0.234, F = 29.354, P <0.001), and NIHSS ( R2 = 114.339, F = 33.338, P <0.001). CONCLUSIONS: Arteriosclerotic IAVWE significantly reduced downstream collateral flow and affected relevant neurological deficits. It was an independent factor affecting downstream collateral flow and NIHSS scores, which should be a focus of future studies. TRIAL REGISTRATION ChiCTR.org.cn, ChiCTR2100053661.
Humans ; Constriction, Pathologic/pathology* ; Magnetic Resonance Imaging/methods* ; Middle Cerebral Artery/pathology* ; Tomography, X-Ray Computed

Objective:To retrieve, review and summarize the best evidence on nonpharmacologic prevention and management of venous thromboembolism (VTE) in patients with ischemic stroke (IS) .Methods:According to the "6S" model, Best Practice, UpToDate, Joanna Briggs Institute (JBI) Evidence-Based Health Care Center Database, PubMed, CINAHL, SinoMed, CNKI, Wanfang, VIP Databases, and dedicated stroke websites in China and abroad were searched for the evidence of nonpharmacologic prevention and management of VTE in IS patients, including clinical decision-making, best practice, evidences summary, guidelines, systematic reviews, expert consensus and randomized controlled trials published up to March 20, 2022. Evidence was extracted and summarized after quality assessment of the literature.Results:A total of 19 articles were included, including 2 clinical decision-making articles, 2 evidences summaries, 8 guidelines, 3 systematic reviews, and 4 expert consensus. A total of 38 pieces of best evidence were collected from 6 aspects: organizational security, risk assessment, screening and diagnosis, basic prevention, mechanical prevention and health education.Conclusions:This study summarizes the best evidence for nonpharmaceutical prevention and management of VTE in IS patients. It is recommended to promote the clinical application of this evidence scientifically and in a planned way through multidisciplinary collaboration in combination with clinical situations, factors promoting and hindering the application of evidences, and patient wishes.

Objective    To explore coronary angiographic characteristics in patients with symptomatic recurrence after coronary artery bypass grafting (CABG). Methods    We performed a retrospective study of 997 patients with symptomatic recurrence after CABG in Beijing Anzhen Hospital from 2010 to 2020. There were 762 males and 235 females, with an average age of 62.41±8.70 years. Results    There was a high prevalence of risk factors like hypertension, diabetes and a history of smoking. Diseased arterial grafts accounted for 27.44% while saphenous vein graft 54.40%; 240 (24.07%) patients had all patent grafts. The main lesion characteristics of diseased grafts were chronic total occlusion lesions (79.57%). Most patients had more diseased native vessels after CABG than before. The type C coronary artery disease in native vessels relevant to ischemic area occurred in 674 (67.60%) patients; 525 (52.66%) patients with recurrent symptom after CABG had both diseased grafts and diseased native vessels. Conclusion     Graft status in patients with symptomatic recurrence after CABG is worse than we expected. The majority have newly developed lesions both in grafts and native vessels. Native vascular lesions will continue to progress after CABG.

Objective:To explore the influencing factors of frailty in elderly patients with coronary heart disease (CHD), and to compare and analyze the value of different frailty scales in screening elderly patients with coronary heart disease.Methods:Using cross-sectional research methods，elderly patients with coronary heart disease from November 2019 to January 2020 in the Department of Cardiology of a tertiary hospital in Zhenjiang City were selected as the research objects. The frailty status of the patients was evaluated by the frailty index scale, and the patients were divided into frailty group (54 cases) and non-frailty group (149 cases) according to the evaluation results. F-test was used for the comparison between measurement data groups conforming to normal distribution, and χ 2 test or exact probability method was used for the comparison of counting data. Multivariate Logistic regression was used to analyze the main influencing factors of elderly patients with coronary heart disease. The correlation and consistency of clinical frail scale, frail scale and frail index were compared and analyzed were analyzed by Spearman correlation and Kappa test. ROC curve was used to analyze the sensitivity, specificity and the area under the working characteristic curve. Results:The age ((78.96±6.78) years), the percentage of monocytes >10% (31.48% (17/54)), the specific index for coronary heart disease ≥4 points (57.41% (31/54)), Barthel index <100 points (85.19% (46/54)), the mini nutritional assessment scale <24 points (66.67% (36/54)) of the patients in the frail group was higher than these in non-frail group ((73.94±5.89) years old, 12.08%(18/149), 7.38%(11/149), 22.15%(33/149), 14.77%(22/149)), the differences were statistically significant (statistical values were t=5.15, χ 2=10.46, χ 2=60.45, χ 2=66.26, χ 2=52.32; P values were <0.001,0.001,<0.001,<0.001,<0.001,respectively). The results of multivariate Logistic regression analysis showed that the percentage of monocytes >10% ( OR=5.927, 95% CI:1.854-18.947), the mini nutritional assessment scale <24 ( OR=7.026, 95% CI:2.660-18.555),the specific index for coronary heart disease ≥4 points ( OR=3.333, 95% CI:1.889-26.850,) and Barthel index <100 points ( OR=15.649, 95% CI:5.403-45.321) are the main effects of frailty in elderly patients with coronary heart disease factors ( P values were 0.003,<0.001,<0.001, and <0.001, respectively). Taking the frailty index as the gold standard, the sensitivity of the clinical frailty scale and FRAIL scale were 85.19% and 85.19%, respectively, and the specificity was 90.60% and 94.63%, respectively, with no significant difference (χ 2 values were 0.000 and 1.767; all P>0.05). The Kappa of the clinical frailty scale scale was <0.75, while the Kappa of the FRAIL scale was >0.75. The consistency of the frail scale with the gold standard was better than that of the clinical frailty scale scale. Conclusion:The percentage of monocytes, the specific index for coronary heart disease, the mini nutritional assessment scale and Barthel index are the main factors affecting the frailty of elderly patients with coronary heart disease. Taking the frailty index score as the standard, the consistency between the screening results of frail scale and frailty index score is better than that of clinical frailty scale scale, which has clinical application value.

Objective:To build the three different risk prediction models for peripherally inserted central catheter (PICC) -associated thrombosis based on machine learning algorithm, and compare the performance of the models, so as to provide a basis for evaluating and preventing PICC-associated thrombosis.Methods:The PICC-associated Thrombasis Risk Factor Questionnaire was developed based on the best evidence and expert consultation. From January 2016 to October 2020, convenience sampling was used to select 626 patients with PICC in the Affiliated Hospital of Jiangsu University as the research object to collect clinical data. Based on machine learning algorithms, Support Vector Machine (SVM) , XGBoost and Logistic regression methods were used to construct three different PICC-associated thrombosis risk prediction models, which were evaluated and compared.. Model evaluation indicators included Matthews correlation coefficient ( MCC) , F1 value, area under the receiver operating characteristic curve ( AUC) and Brier score. Results:A total of 30 variables were included, and the predictors included four aspects, namely, demographic data of patients, patient condition, treatment factors, and catheter-related factors. For the model verified on the test set, the Logistic regression prediction model had lower scores than the XGBoost and SVM prediction models in terms of MCC and F1 values. On AUC, the Logistic regression prediction model score was equal to SVM and smaller than XGBoost. On Brier, the Logistic regression prediction model scored higher than the XGBoost and SVM prediction models. Conclusions:The performance of the prediction model based on the machine learning algorithm XGBoost and SVM is superior to the traditional Logistic regression model in terms of sensitivity and accuracy. Thrombotic predictors can help guide medical and nursing staff to identify high-risk patients and reduce the incidence of PICC-associated thrombosis.

Colorectal cancer is one of the most common malignant tumors. Myeloperoxidase (MPO), as an oxidase in neutrophils lysosomes, plays an important role in activating carcinogenic gene intermediates and enhancing exogenous carcinogenesis. It can stimulate oxidative stress reaction in vivo by producing hypochlorite, reactive oxygen species and other oxidants, and induce gene instability factors such as DNA damage, mutation, mismatch repair and so on, which leads to the occurrence and development of colorectal cancer. MPO single nucleotide polymorphism (SNP) is related to the genetic susceptibility of cancer. Mpors 2333227-463G>A can reduce the risk of colorectal cancer. Therefore, the research on MPO, MPO-463G>A will provide new ideas and strong evidence for early detection, prevention, disease assessment and targeted treatment of colorectal cancer.

Objective:To analyze the operation status of official voice in Beijing municipal hospitals and explore the countermeasures to optimize the operation of official short video tiktok.Methods:The 21 Beijing municipal tertiary public hospitals were selected as the research objects. The 17 tiktok numbers which had been approved by the hospital as of December 31, 2020 were included. The data of basic accounts, fans, points, themes, contents, and number of periodicity were analyzed. The theme and the number of praise of the short video tiktok that broke through 10 thousand times were analyzed. The current situation and problems of official voice in Beijing municipal hospitals were analyzed.Results:The 17 official tiktok accounts of the hospital issued 2 059 pieces of tiktok, 1 737.5 thousand fans, and 9 231.8 thousand times of points, the average number of entries was 4.5 thousand times. The official tiktok construction of Beijing municipal hospitals was still in its infancy. The problems included: the weakening of IP image and the lack of system design, lack of content productivity and interaction, unclear positioning and lack of operation strategy.Conclusions:The optimization of hospital official tiktok operation needs to properly handle the relationship between science and interest, systematicness and efficiency. We should clarify the account positioning, improve productivity, strengthen interaction, enhance linkage, and do a good job in supervision.

Objective:To explore the clinical features and diagnosis methods of atypical chronic myeloid leukemia (aCML).Methods:The clinical data, bone marrow morphology, immunology, genetics and molecular biology characteristics of a young aCML patient in Nan'an Branch of the Second People's Hospital of Yibin City in Sichuan Province were analyzed.Results:The bone marrow smear showed that 0.875 of the granulocyte system showed obvious proliferation, accompanied by significant dysplasia and immature granulocytosis; blasts accounted for 0.170, and the intracytoplasmic granules of mature granulocytes were significantly increased and thickened. Bone marrow puncture biopsy showed bone marrow hyperplasia was extremely active, immature granulocytes were increased, and reticular fiber was extensively proliferated (marrow fibrosis grade 2-3); biopsy pathology results of left inguinal lymph node showed lymph node structure was destroyed, megakaryocytes and immature granulocytes could be seen in the background of histiocytes, in line with the marrow external hematopoiesis; bone marrow flow cytometry immunophenotype showed granulocyte population accounted for 81.6% of nuclear cells, abnormal expression of CD56 and CD14dim, abnormal growth pattern of granulocyte system; 30 common fusion genes in leukemia screening were negative. Polymerase chain reaction (PCR) method showed BCR-ABL1 fusion gene p210 type, BCR-ABL1 fusion gene p190 type, BCR-ABL1 fusion gene p230 type, CALR gene exon 9, JAK2 gene V617F mutation were all negative. Sanger sequencing showed MPL-W515 gene mutation, CSF3R gene exons 14 and 17, BRAF gene mutation, SRSF2 were all negative. Second-generation sequencing showed ASXL1 gene mutation was positive, NM_015338.5: c.2077C>T (p.R693*) and mutation frequency was 47.7%; U2AF1 gene mutation was positive: NM_006758.2: c.101C>A (p.S34V) and mutation frequency was 51%; PDGFRA, PDGFRB, SETBP1, SF3B1, STAT3, STAT5B were all negative. Karyotype analysis showed 47, XX, add(5)(q33), +8, -10, +mar[8]. The integrated examination was diagnosed as aCML with negative BCR-ABL1.Conclusions:The diagnosis of aCML with negative BCR-ABL1 depends on the comprehensive diagnosis of morphology, immunology, genetics and molecular biology. Second-generation sequencing is particularly important in the differential diagnosis and targeted drug therapy. Early diagnosis and treatment of young patients is extremely challenging and should be paid more attention for clinicians.

Objective:To investigate the 2 years’ efficacy of intravesical instillation of domestic BCG versus epirubicin in the prevention of recurrence of intermediate-risk or high-risk non-muscular invasive bladder cancer and predictive factors of BCG instillation.Methods:From July 2015 to June 2020, 18-75 years old patients with moderate to high-risk non muscle invasive bladder cancer (NMIBC) confirmed by pathological examination were involved. The ECOG score was 0-2. Exclusion criteria included ①immune deficiency or impairment (such as AIDS), using immunosuppressive drugs or radiotherapy, suspected allergic to BCG or epirubicin or excipients of the two drugs, fever or acute infectious diseases including active tuberculosis or receiving anti tuberculosis treatment, with severe chronic cardiovascular and cerebrovascular diseases or chronic kidney disease; ②combined with other urogenital system tumors or other organ tumors; ③combined with muscle invasive bladder urothelial carcinoma (≥T 2); ④undergoing chemotherapy, radiotherapy or immunotherapy within 4 weeks (immediate instillation after surgery not included); ⑤ pregnant or lactating women; ⑥ comfirmed or suspected bladder perforation; ⑦gross hematuria; ⑧cystitis with severe bladder irritation that may affect the evaluation; ⑨participat in other clinical trials within 3 months; ⑩alcohol or drug addiction; ?any risk factors that may increasing the risk of patients. Epirubicin 50 mg was irrigated immediately after the operation(TURBT or laser resection). The patients were randomly divided into BCG15 group, BCG19 group and epirubicin group by the ratio of 2∶2∶1, and the patients were maintained intravescical instillation for 1 year. The recurrence and adverse events of the three groups were compared. Univariate and multivariate analysis was performed to predict the risk factors of BCG irrigated therapy failure. Result:By June 15, 2020, the median follow-up duration was 22.1 months(12.1, 32.3), and there was no statistical difference between the groups ( P=0.9024). There were 274 patients enrolled in BCG19 group, 277 patients enrolled in BCG15 group and 130 patients enrolled in the epirubicin group. The drop-off rate was 16.6%(113 cases)and made no difference between groups( P=0.6222). There were no significant difference in age, gender, BMI, or ECOG score( P>0.05). During the follow-up, 116 cases was detected recurrence or progression. The recurrence rate of the three groups was 14.2% and 14.8% in BCG19 group and BCG15 group, and 27.7% in the epirubicin group. There was no difference in recurrence rate between BCG19 and BCG15 group( P=0.9464). The recurrence rate of BCG19 group was lower than that of the epirubicin group ( P=0.0017). The recurrence rate of BCG15 group was lower than that of the epirubicin group ( P=0.0020). There was no difference in the cumulative recurrence free survival rate between BCG19 and BCG15 group (95% CI0.57-1.46, P=0.7173). The cumulative recurrence free survival rate of BCG 19 group was better than that of the epirubicin group( HR=0.439, 95% CI0.26-0.74, P=0.0006), and the cumulative recurrence free survival rate of BCG15 group was better than that of the epirubicin group ( HR=0.448, 95% CI0.29-0.80, P=0.0021). The total incidence of adverse events in 19 BCG19, BCG15 and epirubicin group were 74.5%, 72.6% and 69.8% respectively. There was no difference in the incidence of adverse events between BCG19 and BCG15 group( P=0.6153). The incidence of adverse events in epirubicin group was lower than that of BCG19( P=0.0051) and BCG15( P=0.0167) groups.There was no significant difference in the incidence of serious adverse events (SAE) among the three groups ( P=0.5064). Log rank test univariate analysis and Cox risk regression model multivariate analysis showed that the history of bladder cancer recurrence( HR=6.397, 95% CI1.95-20.94, P=0.0001)was independent risk factor for BCG irrigation failure. Conclusions:The 2 years’ efficacy of intravesical instillation of domestic BCG is better than than of epirubicin with good tolerance and safety. There is no difference between BCG19 and BCG15 group. BCG doesn’t increase SAE compared with epirubicin. Recurrence status was an independent prognostic factor regarding recurrence-free survival.