Abstract:Objective To explore the prediction model based on the early warning factors for poor recovery of left ventricular ejection fraction(LVEF)after coronary artery bypass grafting(CABG)and its significance.Methods 200 patients after CABG in our hospital from January 2022 to June 2024 were analyzed retrospectively,and all patients were divided into a training group(140 cases)and a verification group(60 cases)at the ratio of 7:3.As for the patients'LVEF recovery,good LVEF recovery was defined as the increase in LVEF by≥10%,and poor LVEF recovery was defined as the increase in LVEF by<10%.In the training group,logistics regression was used to analyze the early warning factors for poor LVEF recovery of CABG patients after operation,and the nomogram model was constructed.The ROC curve and calibration curve were drawn to evaluate the prediction of nomogram model.At the same time,the clinical application value of nomogram model was analyzed by decision curve.Results A total of 200 subjects were included in this study.There were 74 patients with poor LVEF recovery,with an incidence rate of 37.00%.Among them,50 patients(35.71%)in the training group had poor LVEF recovery after operation,and 24 patients(40.00%)in the verification group had poor LVEF recovery after operation.There was no significant difference between the data of training and verification groups(P>0.05).Univariate analysis in training group showed that there were significant differences in age,diabetes history,myocardial infarction,LVEDD,LVESD and LVDV between patients with poor LVEF recovery and those with good LVEF recovery(P<0.05).In the training and verification groups,the C-indexes of the nomogram model were 0.804 and 0.890,respectively,which suggested that the nomogram model had a good fitting degree.The AUC of ROC curve was 0.801(95%CI:0.700-0.903)in the training group and 0.885(95%CI:0.780-0.991)in the verification group,suggesting that both groups had good prediction value.Conclusion The poor recovery of LVEF after CABG is related to age,diabetes history,myocardial infarction,LVEDD,LVESD and LVEDV.The nomogram model based on these influencing factors has high prediction efficiency.
Abstract:Acute ischemic stroke(AIS),a common type of stroke characterized by high recurrence rate and high disability rate,stands as one of the primary causes of death and disability in patients.Platelets play a pivotal role in the pathogenesis of AIS,being closely associated with multiple pathophysiological processes such as atherosclerosis,thrombosis and neuroinflammation.In recent years,studies have revealed that platelet parameters and related ratios hold significant clinical value in predicting the prognosis and outcome of AIS.This paper presents a comprehensive review of research advancements concerning a series of platelet derived ratios,including the platelet-lymphocyte ratio(PLR),platelet-neutrophil ratio(PNR),and mean platelet volume/platelet count ratio(MPV/PLT),in the context of AIS.By exploring the associations between these indicators and the occurrence,severity,poor prognosis and complications of AIS,this review aims to highlight their critical significance for formulating early treatment strategies and improving patient outcomes.
Abstract:A 20-year-old woman was admitted with a history of recurrent syncope over the past 2 years and a further episode 6 hours before presentation.During hospitalization,she experienced another episode of unconsciousness,with electrocardiographic monitoring revealing ventricular fibrillation.She received multiple electrical defibrillations,after which her condition stabilized.A fully subcutaneous implantable cardioverter-defibrillator(S-ICD)was subsequently implanted.Since then,the device had delivered multiple effective shocks to treat her ventricular arrhythmias.Over 5 years of follow-up,the patient remained clinically stable.
Abstract:Objective Exploring the clinical value of ultrasound-guided percutaneous high ligation of the great saphenous vein trunk combined with sclerotherapy injection for the treatment of primary great saphenous vein(GSV)varicosities.Methods A retrospective analysis was conducted on 60 patients with unilateral primary GSV varicosities admitted to Jiangdu People's Hospital Affiliated to Yangzhou University.The observation group(30 cases)underwent ultrasound-guided percutaneous trunk ligation combined with polidocanol foam sclerotherapy injection;the control group(30 cases)underwent ultrasound-guided GSV radiofrequency ablation combined with venous injection of sclerosant.The two groups were compared in terms of surgical efficacy(trunk closure rate,symptom relief rate),safety(complications,intraoperative blood loss,postoperative visual analogue scale(VAS)score),and health economic indicators(hospitalisation duration,costs).Results In terms of efficacy,the six-month trunk closure rate in the observation group was 80.00%(24/30),with a symptom relief rate of 96.67%(29/30).;while the control group had a six-month main trunk closure rate of 86.67%(26/30)and a symptom relief rate of 93.33%(28/30).The differences in main trunk closure rate and symptom relief rate between the two groups were not statistically significant(P>0.05).Regarding safety,there were no statistically significant differences in intraoperative blood loss or postoperative VAS scores between the observation group and the control group(P>0.05).Furthermore,the incidence of complications showed no statistically significant difference between the two groups(P>0.05).In terms of health economics indicators,the observation group demonstrated significantly shorter hospital stays and lower hospitalization costs compared to the control group(P<0.05).Conclusion Ultrasound-guided percutaneous suturing combined with sclerotherapy demonstrated no statistically significant difference in efficacy compared to radiofrequency ablation combined with sclerotherapy for treating great saphenous vein varicosities.Moreover,it offers the advantages of being minimally invasive and cost-effective,making it more readily adoptable in primary care hospitals.
Abstract:Transcatheter aortic valve replacement(TAVR)has become an effective treatment for high-risk patients with aortic stenosis(AS),but the occurrence of cardiac conduction block(CCB)after TAVR remains a clinical challenge.This review summarizes the latest research progress on the mechanisms,predictive indicators and management strategies of CCB after TAVR.Studies have shown that the occurrence of CCB after TAVR is related to multiple factors,including anatomical structure,valve type,preoperative electrocardiogram abnormalities,and intraoperative techniques.In terms of postoperative management,the use of temporary pacemakers has become a standard practice,and transitional pacemakers can effectively reduce unnecessary permanent pacemaker implantation.The indications for permanent pacemaker implantation should be comprehensively judged based on the type of conduction block,the patient's clinical manifestations,and cardiac function.Future research needs to further explore the long-term prognosis of CCB,the impact of new valve designs on the conduction system,and the construction of accurate predictive models,so as to provide the more precise and individualized treatment plans for prevention and therapy of CCB after TAVR and to improve the long-term prognosis of patients.
Abstract:Objective To explore the value of the Manchester pain management model(MPMM)in pain management for patients undergoing arthroscopic anterior cruciate ligament reconstruction(ACLR),providing evidence for clinical pain management.Methods A total of 98 patients who underwent ACLR at Lianyungang First People's Hospital from January 2021 to January 2024 were randomly divided into a control group(n=49,receiving conventional pain management)and an observation group(n=49,receiving MPMM-based nursing intervention together with conventional care).Pain levels were assessed at 6 h,12 h,24 h and 48 h postoperatively.Functional exercise compliance,knee function,range of motion,self-efficacy,negative emotions,and quality of life were compared before intervention and at 3 months post-intervention.Results The observation group showed significantly lower pain scores at 12 h,24 h and 48 h[(3.54±0.84),(3.01±0.72),(2.70±0.58),respectively]than the control group[(4.01±1.12),(3.68±0.89),(3.21±0.75),respectively](t=2.350,4.097,3.765,respectively;P<0.05).At 3 months post-intervention,the observation group had higher functional exercise compliance(68.02±7.72 vs.51.36±6.38),better knee function(85.02±8.40 vs.78.31±7.36),and improved self-efficacy(7.48±1.02 vs.5.85±0.71)(t=11.644,9.181,4.206,respectively;P<0.05).Additionally,the observation group exhibited superior quality of life and lower negative emotion scores(P<0.05).Conclusion The MPMM-based nursing can significantly alleviate postoperative pain,enhance functional exercise adherence,promote knee rehabilitation,reduce negative emotions,and improve quality of life in ACLR patients,demonstrating strong clinical applicability.
Abstract:Objective To investigate the impact of catheterization room process reengineering under the Chest Pain Center model on the prognosis and satisfaction of both medical staff and patients in emergency percutaneous coronary intervention(PCI)for patients with acute ST-segment elevation myocardial infarction(STEMI).Methods STEMI patients who underwent primary PCI through the Chest Pain Center from February 2024 to June 2024 were assigned to experimental group.Patients meeting the same criteria from February 2023 to June 2023 were selected as the control group.Comparisons were made between the two groups regarding the first medical contact-to-Catheterization Lab time(FMC-to-Cath Lab,minutes),Cath Lab call-to-door time,door-to-wire time(D-to-W),physician satisfaction,patient satisfaction,the peak value of NT-proBNP during hospitalization,and LVEF before discharge.Results The experimental and control groups showed no statistically significant differences in baseline characteristics including age,gender distribution,smoking status,and proportions of hypertension,diabetes and hyperlipidemia(P>0.05).However,the experimental group demonstrated significantly shorter time intervals compared with the control group in FMC-to-Catheterization Lab time[(23.13±7.72)min vs.(33.20±6.61)min,P=0.001],Cath Lab call-to-door time[(18.61±6.08)min vs.(28.50±5.65)min,P=0.001],and door-to-wire(D-to-W)time[(49.01±12.14)min vs.(66.26±15.52)min,P=0.001].Additionally,the experimental group achieved significantly higher satisfaction scores in both patient satisfaction[(95.45±3.23)points vs.(88.23±5.12)points,P=0.004]and physician satisfaction[(95.33±3.63)points vs.(90.36±6.21)points,P=0.005],with all observed differences reaching statistical significance(P<0.05).Regarding the peak value of NT-proBNP,the experimental group showed lower median value than the control group.For LVEF,the experimental group demonstrated higher median value than the control group,with statistically significant difference.Conclusion Catheterization room process reengineering can improve the efficiency of the catheterization lab,shorten the activation time for emergency PCI,significantly reduce the Cath Lab call-to-door time and D-to-W time,and enhance both patient and physician satisfaction.This approach is beneficial for improving patient prognosis.
Abstract:Objective This study aimed to determine the frequency of fecal incontinence and constipation in patients with ulcerative colitis(UC)in remission,and to explore the association of these two symptoms with patients'negative emotions and quality of life.Methods A total of 264 patients with UC in remission,who were treated in Lianyungang First People's Hospital from November 2020 to November 2023,were selected as the research subjects.General information questionnaire,Cleveland Clinic Florida Fecal Incontinence Scale,Fecal Incontinence Quality of Life Scale,Hospital Anxiety and Depression Scale,and Patient Assessment of Constipation Quality of Life Questionnaire were used for the survey.The anxiety score,depression score and quality of life score were compared between the fecal incontinence group and the normal defecation group,and between the constipation group and the normal defecation group.Pearson correlation analysis was used to analyze the association of fecal incontinence and constipation with depression,anxiety and quality of life.Results Among the 264 patients,24 had fecal incontinence with an incidence rate of 9.1%,and 43 had constipation with an incidence rate of 16.3%.The anxiety scores and depression scores of patients with fecal incontinence or constipation were significantly higher than those of the normal defecation group,and their quality of life was significantly lower than that of the normal defecation group,with statistically significant differences(P<0.05).Pearson correlation analysis showed that the patient's fecal incontinence score was positively correlated with the anxiety scale score(r=0.767,P<0.05),and positively correlated with the depression scale score(r=0.769,P<0.05).The constipation score was positively correlated with the anxiety scale score(r=0.466,P<0.05),and positively correlated with the depression scale score(r=0.317,P<0.05).The fecal incontinence score was significantly negatively correlated with the quality of life score(r=-0.318,P<0.05),while the constipation score was significantly positively correlated with the quality of life score(r=0.572,P<0.05).Conclusion Some patients with UC in remission still have intestinal symptoms such as fecal incontinence and constipation,which have a serious impact on patients'quality of life,indicating that clinical treatment and intervention for fecal incontinence and constipation in patients with UC in remission need to be further strengthened.
Abstract:Objective To summarize the best evidence on the central venous line management for parenteral nutrition in critically ill patients at home and abroad.Methods Based on the"5 S"evidence pyramid model,we searched in a top-down order for practice guidelines,clinical decisions,evidence summaries,expert consensus,systematic evaluations,and original studies on infusion standardization,nursing care,and monitoring of complications for parenteral nutrition in critically ill patients.Two investigators independently assessed the quality of the included literature and integrated the evidence with the judgment of clinical experts.Results A total of 9 papers were included,including 2 clinical decisions,1 systematic evaluation,1 evidence summary,3 expert consensus,and 2 RCTs.Through literature reading and evidence integration,18 pieces of evidence were summarized in 5 areas:management and training,line selection,skin disinfection,use of drug delivery devices,and flushing and sealing tubes.Conclusion The summarized best evidence is to provide safe norms for parenteral nutrition therapy in critically ill patients.
Abstract:Objective To explore the effectiveness of combining three-dimensional(3D)printing technology with case-based learning(CBL)teaching model in clinical nursing education for intracranial aneurysm,aiming to improve teaching quality.Methods A total of 84 students specializing in clinical nursing for intracranial aneurysm surgery from a tertiary hospital in 2023 were randomly assigned to the 3D printing group and the traditional group.The 3D printing group used 3D-printed aneurysm models combined with the CBL teaching method,while the traditional group utilized conventional teaching tools along with the CBL method.After the teaching sessions,the educational outcomes of both groups were assessed and compared through evaluations and surveys.Results The 3D printing group achieved significantly higher scores in final assessment results,critical thinking ability evaluation and teaching satisfaction compared with the traditional group[(72.8±14.3)vs.(54.3±12.5),t=6.31,P<0.05;(298.50±1.15)vs.(281.20±0.70),t=12.40,P<0.01;and(4.48±0.58)vs.(4.22±0.65),t=3.34,P<0.01],respectively.Conclusion The combination of 3D printing technology with CBL teaching can significantly improve educational outcomes in clinical nursing education for intracranial aneurysm surgery.
Abstract:Objective Using ear acupoint seed embedding combined with Five-Element music therapy to intervene in elderly patients with coronary heart disease,to explore the effects on their anxiety,depression and sleep quality.Methods 107 elderly patients with coronary heart disease admitted to the First People's Hospital of Lianyungang City from December 2021 to November 2023 were selected as the research subjects.According to the admission time,the patients were divided into a control group and an observation group.The control group received routine nursing care,while the observation group received ear acupoint seed embedding combined with Five-Element music therapy on the basis of routine nursing care.Clinical outcomes were evaluated using the Hamilton Anxiety Scale(HAMA),Hamilton Depression Scale(HAMD)and Pittsburgh Sleep Quality Index(PSQI),and a nursing satisfaction survey was conducted.Results After intervention,the HAMA and HAMD scores of the two groups of patients were both lower than those before intervention,with statistically significant differences(P<0.05),and the HAMA and HAMD scores of the observation group were lower than those of the control group,with statistically significant differences(P<0.05).After intervention,the PSQI score of the observation group was lower than that before intervention,and the difference was statistically significant(P<0.05).And the PSQI score of the observation group was lower than that of the control group,and the difference was statistically significant(P<0.05).After intervention,the nursing satisfaction of the observation group(89.3%)was higher than that of the control group(62.7%),and the difference was statistically significant(P<0.05).Conclusion Ear acupoint seed embedding combined with Five-Element music therapy can alleviate anxiety and depression in elderly patients with coronary heart disease,improve sleep quality,and enhance nursing satisfaction.This method is simple and safe.
Abstract:Objective To investigate the effect of peer education on the compliance of primary liver cancer patients with drug-loaded microspheres interventional therapy.Methods A total of 80 patients with primary liver cancer receiving drug-loaded microspheres interventional therapy from September 2020 to September 2022 were randomly divided into experimental group and control group,40 cases in each group.The experimental group received peer education,and the intervention time was from admission to discharge 1 month;the control group received routine nursing.The degree of psychological pressure,the degree of mastery of relevant specialized knowledge and the degree of perioperative nursing cooperation between the two groups were compared.Results In the experimental group,psychological stress levels at discharge and 1 month post-discharge demonstrated significant reduction compared to admission(F=29.22,P<0.001).Regarding outcome measures at 1 month post-discharge,the experimental group showed superior performance compared to the control group in both disease-specific knowledge mastery[(65.90±7.09)vs.(52.50±7.06),P<0.001]and perioperative nursing cooperation[(65.15±3.08)vs.(57.08±5.24),P<0.001].Conclusion Peer education can effectively reduce the degree of psychological stress in patients with primary liver cancer treated with drug-loaded microspheres,enable drug-loaded patients to better grasp the relevant knowledge of disease treatment,improve the degree of perioperative nursing cooperation,and reduce postoperative adverse reactions.
Abstract:Cardiomyopathy is a group of myocardial disorders that are clinically common and characterized by complex etiologies,heterogeneous clinical manifestations,adverse prognoses and strong associations with genetics.In recent years,significant advances and breakthroughs have been achieved in its definition,classification,precise diagnosis,and individualized treatment.This guideline integrates the latest evidence,systematically elucidates the definition,classification,etiologies and pathogenesis of various types of cardiomyopathy,and offers recommendations for diagnosis,treatment and management,with the aim to improve the clinical practice level of cardiomyopathy in China.
Abstract:Objective To explore the application effect of 3 D printing technology in the standardized training of cardiovascular medicine specialists and provide new ideas for improving training quality.Methods A total of 40 cardiovascular medicine residents with no experience in surgical treatment of coronary heart disease or structural heart disease were selected from the First Affiliated Hospital of Nanjing Medical University from January to December 2024.They were randomly divided into an experimental group(20 residents,receiving theoretical lectures+3 D printing technology training)and a control group(20 residents,receiving only theoretical lectures).The teaching durations for both groups were the same.The teaching effect was evaluated through course assessments(diagnostic accuracy,standardized surgical operation procedures),teaching situation questionnaires(theoretical level,satisfaction with explanation,operation guidance level)and self-assessment questionnaires(learning ability,problem analyzing ability,etc.).SPSS 23.0 was used for statistical analysis.Results The score of standardized surgical operation procedures in the experimental group(42.15±3.00)was significantly higher than that in the control group(37.65±3.41,t=4.30,P<0.01),and there was a significant difference in diagnostic accuracy between the two groups(t=2.54,P=0.02).The score of the teaching situation questionnaire in the experimental group(53.35±1.65)was significantly higher than that in the control group(51.50±1.66,t=3.45,P<0.01).In the self-assessment questionaires,the scores of learning ability,problem analyzing ability and practical work ability in the experimental group were significantly higher than those in the control group(t=3.53,P<0.01;t=4.77,P<0.01;t=5.09,P<0.01,respectively),but there was no significant difference in the score of teamwork ability(t=0.82,P>0.05).Conclusion 3 D printing technology-assisted teaching can significantly improve standardized surgical operations,teaching satisfaction and core abilities(learning ability,problem analyzing ability and practical work ability)of cardiovascular medicine residents,providing an efficient new method for the standardized training of specialists.
Abstract:Cannula misplacement into transverse sinus of pericardium via atrial septal dissection(ASD)is a rare complication of transseptal access.We present a patient who developed ASD by the method of ablation catheter probing of the previous transseptal puncture site during percutaneous radiofrequency ablation for atrial fibrillation.The catheter and long sheath were advanced into transverse pericardial sinus via ASD.3 D rotational fluoroscopy and cardiac magnetic resonance imaging were performed to confirm the diagnosis.We emphasize that atrial septal puncture at lower site of oval fossa and recording the puncture trail by 3 D mapping system to guide the second transseptal access should be considered to avoid this complication.
Abstract:Obesity,diabetes,cardiovascular disease and chronic kidney disease often coexist,which seriously endangers human health and has become a major public health problem in China.At present,there is still a lack of effective interdisciplinary collaboration in clinical diagnosis and treatment for patients with multiple diseases coexisting simultaneously.The American Heart Association has released a presidential advisory on cardiovascular-kidney-metabolic(CKM)syndrome,aimed at strengthening multidisciplinary collaborative management of comorbidities.The expert consensus is based on relevant clinical research evidence at home and abroad,while drawing on and referring to clinical guidelines in related fields.It summarizes the epidemiology,physiological and pathophysiological mechanisms,staging characteristics,screening,risk assessment,clinical management and treatment pathways of CKM syndrome,lifestyle medical management,community chronic disease management,public health prevention policies,and patient education.We aim to enhance the diagnostic and treatment capabilities of medical personnel in China regarding CKM syndrome,as well as the management level of chronic diseases,in order to further improve the prognosis of patients in China.
Abstract:Chronic pancreatitis is a common clinical disease,with a high incidence rate and significant recurrence rate.Given its importance in clinical management,this consensus aims to comprehensively expound the cognitive framework,diagnostic strategies,and treatment methods of chronic pancreatitis from the perspectives of traditional Chinese and Western medicine theory and practice,and deeply analyze the latest research achievements in the field of chronic pancreatitis.The goal is to provide clinical physicians with a set of scientific,accurate,and highly operational guidance programs to promote the continuous improvement of the diagnosis and treatment level of chronic pancreatitis.
Abstract:Objective To investigate the causes of triage errors in the initial diagnosis process for patients with acute pulmonary embolism(APE)and acute aortic syndrome(AAS).Methods A retrospective analysis was conducted on the clinical data of APE and AAS patients who were initially diagnosed in the Department of Cardiology at Putian First Hospital from July 2022 to February 2025.Their basic information,treatment plans,and in-hospital outcomes were recorded.Results A total of 35 patients were included,with 30 cases(85.7%)of APE and 5 cases(14.3%)of AAS.The latter included 2 cases of acute aortic dissection,2 cases of acute intramural aortic hematoma,and 1 case of aortic arch aneurysm with penetrating ulcer.The main symptoms were dyspnea in 19 cases(54.3%)and chest tightness in 17 cases(48.6%).The onset time ranged from 1 hour to half a year,with a median time of 2 days.There were 20 cases(57.1%)of patients seeking medical treatment during regular working hours,and 15 cases(42.9%)during noon breaks and nighttime.The time from admission to diagnosis ranged from 2 to 190 hours,with a median time of 30 hours.The positive rate of N-terminal pro-B-type natriuretic peptide was 61.3%(19/31),of high-sensitivity cardiac troponin I was 41.9%(13/31),and of D-dimer was 100%(35/35).The abnormality rate of electrocardiogram was 90.0%(27/30).Among the 30 APE patients,20 received anticoagulant therapy on the day of admission,while 10 did not.Two patients(5.7%)underwent emergency coronary angiography under digital subtraction angiography.Twenty-one patients(60.0%)received interventional treatment,including 4 cases(11.4%)of inferior vena cava filter placement,4 cases(11.4%)of pulmonary artery catheter-directed thrombolysis,11 cases(31.4%)of combined inferior vena cava filter placement and pulmonary artery catheter-directed thrombolysis,and 2 cases(5.7%)of thoracic aortic stent-graft placement.All patients had favorable in-hospital outcomes with no adverse events.Conclusion Objectively speaking,triage errors exist in the initial diagnosis process for APE and AAS in clinical practice.Optimizing the diagnostic and treatment process,with early chest contrast-enhanced CT scanning as a key measure,can help reduce triage errors in the initial diagnosis process.