Background Stroke patients commonly experience varying degrees of psychological distress.Previous studies have shown that the psychological distress of stroke patients is closely related to their coping styles and resourcefulness.However,the path of wisdom in coping style and psychological pain of stroke patients is still unclear.Objective To explore the path of resourcefulness between coping styles and psychological distress in stroke patients,so as to provide insights for interventions targeting psychological distress.Methods A total of 350 patients who met the diagnostic criteria for stroke according to the Diagnostic Criteria of Cerebrovascular Diseases in China(version 2019)and were admitted to the neurology departments of two tertiary grade-A hospitals in Luzhou City from January to May 2023 were selected as the research subjects.Basic information was collected using a self-designed questionnaire,and Resourcefulness Scale(RS),Medical Coping Mode Questionnaire(MCMQ)and Distress Thermometer(DT)were used for assessment.Pearson correlation analysis was conducted to examine the correlation between the scores of each scale.Model 4 of the Process 3.4.1 program was employed to analyze the path of resourcefulness between coping styles and psychological distress,and the Bootstrap method was used to test the mediation effects.Results The DT score showed a negative correlation with the confrontation and RS scores(r=-0.581,-0.716,P<0.01),and a positive correlation with the avoidance and resignation scores(r=0.432,0.758,P<0.01).The confrontation score was positively correlated with RS score(r=0.700,P<0.01),while the avoidance and resignation scores were negatively correlated with RS score(r=-0.460,-0.566,P<0.01).Resourcefulness might serve as a mediating path between confrontation,avoidance,resignation,and psychological distress,with the effect value of-0.359,0.203 and 0.183,accounting for 81.78%,62.65%and 27.07%of the path effect,respectively.Conclusion The coping styles of stroke patients can directly affect their psychological distress,and can also indirectly influence it through resourcefulness.Resourcefulness may play a mediating role between coping styles and psychological distress.

Brugada syndrome presents mainly in adulthood,and sudden death occurs mainly at rest or during sleep.It is uncommon in childhood,especially with atrial flutter as the first manifestation.In this article,we report a case of a 13-year-old child with atrial flutter as the first manifestation,without underlying cardiac disease,who developed Brugada-like electrocardiographic changes during the treatment of propafenone,and genetic testing revealed the suspected mutant genes SCN5A(c.2834A＞G[p.D945G]).Present case and related literature review might improve the awareness of clinicians on the inducing factors of Brugada syndrome and related a variety of cardiac arrhythmias,the importance of electrocardiogram monitoring during the application of antiarrhythmic drugs,and provide guidance and close follow-up strategies to this high-risk group,so as to avoid the occurrence of adverse events in these patients.

Objective:To explore the current status and influencing factors of medical narrative competence among nurses in Luzhou, offering theoretical insights for improving nurses′ narrative competence.Methods:This study was a cross-sectional survey. From July 2021 to January 2022, using convenience sampling method, 267 nurses from Zhongshan Area of Affiliated Hospital of Southwest Medical University, Kangjian Area of Affiliated Hospital of Southwest Medical University and the Traditional Chinese Medicine Hospital Affiliated to Southwest Medical University were investigated by the general information questionnaire, Narrative Competence Scale, Nurses′ Perceived Professional Benefits Questionnaire And Perceived Social Support Scale.Results:The total scores of narrative competence of the 267 nurses was (142.25 ± 19.03), nurses′ perceived professional benefits was (137.16 ± 15.89) and perceived social support was (65.86 ± 10.38). The results of multiple linear regression showed that nurses′ perceived professional benefits and perceived social support were the important factors affecting their narrative ability ( t = 5.09 and 5.95, both P<0.05), which could account for 35.7% of the total variation of narrative competence. Conclusions:Nurses have narrative competence at low level in Luzhou. Managers should pay more attention to nurses who have poor level of perceived professional benefits and perceived social support, so as to keep the nurses′ mental health and improve nurses′ narrative competence by taking corresponding measures.

Objective:To investigate the application value of manual anastomosis of gastro-duodenum in totally laparoscopic distal gastrectomy.Methods:The retrospective cohort study was conducted. The clinicopathological data of 55 patients with gastric cancer who underwent totally laparoscopic distal gastrectomy combined with gastrointestinal anastomosis in the Tianjin Medical University Cancer Institute & Hospital from January 2020 to October 2022 were collected. There were 34 males and 21 females, aged 61(range, 29?75)years. Of 55 patients, 25 patients undergoing manual anastomosis of gastroduodenum were divided into the manual anastomosis group, 30 patients undergoing modified Delta anastomosis of gastroduodenum were divided into the modified Delta anastomosis group. Observation indicators: (1) surgical situations; (2) postoperative complications. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers, and comparison between groups was conducted using chi-square test or Fisher exact probility. Results:(1) Surgical situations. All 55 patients underwent surgery successfully, without conversion to laparotomy. The distance from the superior margin of tumor to the upper margin, anastomosis time, number of bookings used were (48±4)mm, (22.6±2.3)minutes, 3.2±0.5 in the manual anastomosis group, versus (41±4)mm, (14.0±1.4)minutes, 5.2±0.4 in the modified Delta anastomosis group, showing significant differences in the above indicators between the two groups ( t=5.04, 16.38, ?17.13, P<0.05). The location of tumor (antrum, gastric angle) was 18, 7 in the manual anastomosis group, versus 29, 1 in the modified Delta anastomosis group, showing a significant difference between the two groups ( P<0.05). (2) Postoperative complications. There was no patient undergoing anastomotic fistula in both of manual anastomosis group and modified Delta anastomosis group, and there was 1 patient undergoing anastomotic stenosis in the modified Delta anastomosis group. Conclusion:Compared with modi-fied Delta anastomosis of gastroduodenum,totally laparoscopic distal gastrectomy with manual anas-tomosis of gastroduodenum can remove more gastric tissue, and decrease the number of bookings used.

Since the outbreak of corona virus disease 2019(COVID 19), the epidemic has spread rapidly, which brings great challenge to the surgical diagnosis, treatment and management of lung neoplasm Sichuan International Medical Exchange &Promotion Association organized thoracic surgery experts to sum up experiences from experts in major hospital, and formulated the Guidance suggestion on surgical diagnosis, treatment and management of lung neoplasm during the outbreak of COVID-19 to provide references for thoracic surgeons.

Objective: To analyze the clinical characteristics of Kawasaki disease in infants and explore the risk factors of coronary artery abnormities in Kawasaki disease. Methods: The clinical data of 300 children with Kawasaki disease from January 1, 2018 to December 31, 2018 were retrospectively analyzed, including laboratory tests and coronary ultrasound results.The clinical characteristics of infants with Kawasaki disease and elderly children with Kawasaki disease were compared.The risk factors of coronary artery injury in infants with Kawasaki disease were analyzed. Results: The majority of infants with Kawasaki disease were atypical Kawasaki disease, and the typical changes of conjunctival congestion, perianal changes and plaque were significantly higher than those of elderly children (P<0.01). Leukocyte count and platelet count were higher in the infant group, and the number of children with abnormal liver function was significantly higher than that in the older group (P<0.05). Coronary artery dilatation occurred in 11% of infants with Kawasaki disease, and most of them returned to normal within 3 months.Logistic model design was used to analyze the risk factors of coronary artery injury in infants with Kawasaki disease.It was found that boys and CRP increased significantly were the risk factors of coronary artery injury in infants with Kawasaki disease. Conclusion Infant Kawasaki disease has its own characteristics.The incidence of coronary artery injury is high.Timely diagnosis, differential diagnosis and symptomatic treatment may reduce the incidence of coronary artery injury.At the same time, follow-up should be maintained to monitor the changes of coronary artery by echocardiography.

Objective To compare the clinical features of classic Kawasaki disease (CKD) and in-complete Kawasaki disease (IKD),and to explore the risk factors of coronary artery abnormities in Kawasaki disease. Methods We collected the clinical data of 320 children with Kawasaki disease from July 1,2017 to June 30,2018,including 244 children with CKD (CKD group) and 76 children with IKD (IKD group). The risk factors of coronary artery abnormities in children with Kawasaki disease were explored. Results In ad-dition to coronary artery injury ( 5%), some patients showed other rare complications such as cholestasis (1. 6%),intestinal obstruction(0. 6%),atlantoaxial subluxation (0. 9%),macrophage activation syndrome (0. 9%) and Kawasaki disease shock syndrome (0. 3%). The age onset in CKD group was earlier than that in IKD group. WBC, CPR, NT-proBNP in CKD group were significantly higher than those in IKD group (P<0. 05). After one week of treatment,WBC and CRP decreased significantly in group IKD,and there was no significant difference in PLT count. Multivariate logistic model was used to analyze the risk factors of cor-onary artery abnormities in Kawasaki disease. It was found that 25-OH VitD reduction ( OR ＝2. 851,P <0. 05) was a high risk factor for coronary artery injury in KD. Conclusion Kawaski disease should be diag-nosed early, treated for organ damage and supplemented with vitamin D. After discharge, coronary artery changes should be monitored regularly.

Objective To investigate the clinical features and prognosis in ventricular noncompaction children. Methods Thirty-four cases who diagnosed with ventricular noncompaction were included in this study in Shengjing Hospital of China Medical University from January 2012 to May 2018. According to age, the children were divided into infantile type( age <1 year old) and juvenile type( age≥1 year old) . We ana-lyzed the clinical features,laboratory tests and prognosis. Results The average age at diagnosis was 3 years and 2 months. The sex ratio was 2. 4:1. Of these,32 cases were left ventricular noncompaction,1 was right ventricular noncompaction, and 1 was biventricular noncompaction. There were no statistically significant differences in family history,arrhythmia,and thrombotic events between infantile type and juvenile type. Heart failure was the first reason for most children,while older children often presented with fatigue when at diag-nosis. More than half of them showed significant left ventricular ejection fraction(LVEF) decreasing,and non-compacted layer to compacted layer(N/C) ratio showed negative correlation with LVEF(r= -0. 74, P<0. 001). Sixty-five percent(22/34) of the patients presented abnormal electrocardiogram. During the follow-up,one patient died of pulmonary embolism. No significant LVEF improvement was found in 35％(12/34) of the patient. The COX proportional hazards model showed that N/C ratio was an independent risk factor for poor prognosis of ventricular noncompaction(OR=14. 46,95％CI 1. 712 -120. 234,P<0. 05). Conclusion Children with ventricular noncompaction showed different clinical features and prognosis. Early diagnosis,treatment and long term follow up are key issues for the prognosis.

Two cases of hypoglossal canal dural arteriovenous fistulas (HCDAVF) were reported. The clinical manifestation, radiological features, treatment and prognosis were reviewed. Both cases presented chemosis and pulsatile tinnitus. 3D-time-of-flight (TOF) magnetic resonance angiography (MRA) demonstrated abnormal high signal in hypoglossal canal. Cerebral digital subtraction angiography (DSA) showed that these HCDAVFs were supplied by multiple intracranial and extracranial arteries, and fistulas were located in hypoglossal canal. Fistulas were blocked by coils and Onyx-18 through transvenous approach, and the angiography after the embolism showed complete occlusion of fistula. No adverse events after treatment and no recurrence during the follow up were observed.

Cardiogenic shock is caused by dysfunction of the cardiac pump,resulting in multiple or-gan failure and metabolic disturbances. Because of its rapid onset,various manifestations,rapid progress and high mortality rate,it becomes one of the critical diseases in pediatrics. Early diagnosis and active treatment is the key to improve prognosis. The application of hemodynamic monitoring and mechanical circulatory assist devices play an increasingly important role in the treatment of cardiogenic shock in children.