Objective  To systematically assess the causal relationship of circulating inflammatory cytokines and antioxidants with coronary atherosclerosis, aiming to overcome the limitations of confounding factors and reverse causation in traditional observational studies. Methods  We performed a two-sample Mendelian randomization analysis using genetic instrumental variables for 27 inflammatory cytokines (n=8 293) and 4 antioxidants (n=86 995) from European cohorts. Data of coronary atherosclerosis were obtained from the FinnGen database (23 363 cases and 187 840 controls) and the UK Biobank (14 334 cases and 346 860 controls). The inverse-variance weighted method was used as primary analysis method, and multiple sensitivity analyses were conducted to assess the robustness of the results. Results  In the Finnish cohort, genetically predicted higher C-reactive protein (CRP) levels significantly increased the risk of coronary atherosclerosis (OR=1.160, 95%CI 1.095-1.228, P=4.60×10-7). TRAIL showed a positive association (OR=1.067, 95%CI 1.031-1.103, P=1.96×10-4), whereas tumor necrosis factor-α (TNF-α; OR=0.917, 95%CI 0.843-0.999, P=0.047) and α-tocopherol (OR=0.554, 95%CI 0.344-0.890, P=0.015) exhibited protective effects. Validation in the UK Biobank cohort confirmed the findings for CRP (OR=1.007,95%CI 1.005-1.009, P=2.69×10-11), and revealed additional associations of TNF-β and RANTES with coronary atherosclerosis. No causal relationship was found between members of the interleukin family and coronary atherosclerosis. Conclusion  This study provides genetic evidence for establishing the causal roles of specific inflammatory cytokines and antioxidants in the development of coronary atherosclerosis. Interventions targeting CRP and TRAIL, as well as increasing α-tocopherol levels, may offer novel strategies for early prevention of atherosclerotic disease.

Objective  To investigate the clinical characteristics of patients with type 2 diabetes mellitus (T2DM) complicating microvascular angina, and their correlation with coronary flow reserve (CFR). Methods  A total of 82 patients with T2DM complicating microvascular angina were enrolled. General data, medical history, lifestyle habits, blood glucose, blood lipids, and other clinical characteristics were collected. CFR was measured by echocardiography to assess coronary microvascular function. Pearson correlation analysis was used to explore the correlation between clinical characteristics and CFR. Results  Among the 82 patients, there were 48 males (58.54%) and 34 females (41.46%), with a mean age of (55.32±8.56) years, body mass index (BMI) of (26.45±3.21) kg/m2; there were 53 cases (64.63%) of hypertension, and 58 cases (70.73%) of hyperlipidemia. Fasting blood glucose was (8.65±2.13) mmol/L, 2-hour postprandial blood glucose was (13.56±3.24) mmol/L, glycated hemoglobin was (8.12±1.56)%, total cholesterol was (5.86±1.23) mmol/L, triglycerides was (2.56±0.89) mmol/L, low-density lipoprotein cholesterol was (3.65±0.98) mmol/L, and high-density lipoprotein cholesterol was (1.05±0.23) mmol/L. Angina pectoris occurred (3.56±1.23) times per week, with each episode lasting (10.23±3.56) minutes. It was mostly induced by physical activity or emotional excitement, mainly manifesting as substernal squeezing pain. The mean CFR of the patients was 1.86±0.56. Patients with a history of hypertension or hyperlipidemia showed significantly reduced CFR (both P<0.05). Age, BMI, and levels of blood glucose and lipid-related parameters were all negatively correlated with CFR (all P<0.01). Conclusion  Patients with T2DM complicating microvascular angina have distinct clinical characteristics, and characteristics such as age, BMI, blood glucose and lipids are closely correlated with CFR. Coronary microvascular function can be preliminarily estimated based on clinical characteristics, providing reference for treatment.

Objective  To investigate the influencing factors for postpartum post-traumatic stress disorder (PTSD) in puerperae with hypertensive disorders of pregnancy (HDP), and to construct a Logistic regression prediction model for screening high-risk patients. Methods  A total of 400 HDP puerperae were enrolled as study subjects, and divided into a PTSD group (112 cases) and a pure HDP group (288 cases) according to whether PTSD occurred at 3 months after delivery. Clinical data were compared between the two groups, the influencing factors for postpartum PTSD were analyzed; a Logistic regression model was constructed, and evaluated using ROC curve, calibration curve and decision curve analyses. Results  Poor sleep quality, low social support, postpartum depression, neonatal complications, abnormal labor process, unemployment status, history of psychological trauma, low sense of coherence, history of postpartum hemorrhage, and high prenatal C-reactive protein-to-albumin ratio (CAR) were independent risk factors for postpartum PTSD (all P<0.05). The area under the ROC curve for the Logistic regression model in predicting postpartum PTSD was 0.897; the model yielded good fit, good consistency and a favorable clinical net benefit. Conclusion  The constructed prediction model has certain predictive value for postpartum PTSD in HDP puerperae.

Objective  To explore the combined diagnostic value of P-wave dispersion (Pd), Tp-Te interval, and QT dispersion (QTd) on ambulatory electrocardiography (AECG) for coronary heart disease (CHD), and to provide reference for clinical diagnosis of CHD. Methods  A total of 209 patients with suspected CHD were selected. Coronary angiography was used as the gold standard, and patients were divided into a positive group (n=112) and a negative group (n=97). All patients underwent AECG examination, and Pd, Tp-Te interval and QTd were measured. The differences in these parameters between the two groups were compared. The diagnostic efficacy of each individual parameter and their combination for CHD was analyzed using receiver operating characteristic (ROC) curves. Results  The Pd, Tp-Te interval, and QTd in the positive group were all significantly higher than those in the negative group (all P<0.05). ROC curve analysis showed that Pd, Tp-Te interval, and QTd alone or in combination all had diagnostic value for CHD (P<0.05). Among them, the combined detection yielded an area under the curve (AUC) of 0.842 (95%CI 0.778-0.907), with a sensitivity of 83.93%, specificity of 82.47%, and Youden index of 0.664, all significantly higher than those of each parameter alone. Conclusion  The combined detection of Pd, Tp-Te interval, and QTd on AECG can effectively improve the diagnostic efficacy for CHD. It is simple, non-invasive, and can serve as an auxiliary diagnostic tool for CHD in clinical practice.

Objective  To investigate the influencing factors for prolonged corrected QT interval (QTc) on electrocardiogram (ECG) in long-term hospitalized patients with schizophrenia, and to construct a prediction model. Methods  A total of 83 long-term hospitalized patients with schizophrenia were retrospectively enrolled as study subjects, all of whom received routine treatment. Patients were divided into a prolonged group (n=19) and a non-prolonged group (n=64) according to QTc value. General data and disease-related characteristics of all patients were collected. Factors influencing QTc prolongation in long-term hospitalized patients with schizophrenia were screened using LASSO regression and Logistic regression, and a nomogram prediction model was constructed; the predictive performance of the model was evaluated using ROC curve, calibration curve and decision curve analyses. ResultsThere were statistically significant differences between the prolonged group and the non-prolonged group in age, sex, BMI, number of medication types, and serum potassium level (all P<0.05). Through LASSO regression analysis for non-zero coefficient feature selection, three characteristic variables—age, BMI, and number of medication types, were ultimately selected. Multivariate Logistic regression showed that age, BMI, and number of medication types were independent influencing factors for QTc prolongation in long-term hospitalized patients with schizophrenia (all P＜0.05). ROC curve analysis results showed that the area under the curve for the combination of the above three indicators in predicting QTc prolongation was 0.877 (95%CI 0.781-0.972), indicating good discriminative ability of the nomogram model. The Hosmer-Lemeshow test showed no significant deviation between the model-predicted probability and the actual probability (χ2=12.243, P＞0.05), indicating good calibration of the model. Decision curve analysis results showed that the model yielded a higher net benefit for clinical prediction. Conclusion  Factors influencing QTc prolongation on ECG in long-term hospitalized patients with schizophrenia include age, BMI, and number of medication types. The nomogram risk early-warning model constructed based on the above factors has certain predictive value for QTc prolongation in this population.

Objective  To investigate the changes of heart rate variability (HRV) in patients with stroke-related sleep disorders, and its relationship with sleep structure and quality. Methods  A total of 86 patients with stroke-related sleep disorders were retrospectively enrolled as a sleep disorder group, while 86 patients with stroke alone were enrolled as a stroke-alone group in a 1∶1 ratio during the same period. Sleep quality was assessed using the Pittsburgh sleep quality index (PSQI), sleep structure was evaluated using polysomnography (PSG), and HRV indexes were assessed using 24-hour ambulatory electrocardiography. PSQI scores, sleep structure parameters, HRV indexes, and clinical data were compared between the two groups. Multivariate Logistic regression analyses were used to identify factors influencing sleep disorders in stroke patients. Pearson correlation analysis was used to examine the relationships between HRV indexes, and PSQI scores and sleep structure parameters. Results  The proportions of patients with anxiety, depression, and left hemisphere lesions in the sleep disorder group were significantly higher than those in the stroke-alone group (all P<0.05). Total sleep time (TST) and rapid eye movement sleep time (REM)/TST were shorter, sleep latency and wake after sleep onset (WASO) were longer, and spontaneous arousal index (SAI), low-frequency power (LF) and PSQI scores were higher in the sleep disorder group than those in the stroke-alone group, while N2 spindle density, high-frequency power (HF) and SDNN were lower in the sleep disorder group than those in the stroke-alone group, all with statistically significant differences (all P<0.05). There were no statistically significant differences between the two groups in N1/TST, N2/TST, or N3/TST (P>0.05). Multivariate Logistic regression analysis showed that TST, sleep latency, WASO, SAI, N2 spindle density, LF, HF, and SDNN were factors influencing the development of sleep disorders in stroke patients. Pearson correlation analysis revealed that SDNN was negatively correlated with SAI and PSQI scores (r=-0.179、-0.211, all P<0.05), and positively correlated with N2 spindle density (r=0.216, P<0.05); LF was positively correlated with SAI (r=0.170, P<0.05), and negatively correlated with N2 spindle density (r=-0.181, P<0.05); HF was negatively correlated with SAI (r=-0.189, P<0.05). Conclusion  Patients with stroke-related sleep disorders exhibit a dual disturbance of sleep quality and sleep structure. HRV changes are closely associated with sleep quality and its structure, suggesting that autonomic nervous system dysfunction may be an underlying pathogenic mechanism.

Objective  To compare the clinical diagnostic value of treadmill exercise test (TET) and routine electrocardiogram (ECG) examination for coronary heart disease (CHD). Methods  A total of 91 patients with suspected CHD were enrolled. All patients underwent TET and routine ECG examination on admission, and coronary angiography (CAG) examination was performed at an appropriate time. Using CAG results as the gold standard, the consistency, sensitivity, specificity, accuracy rate, positive predictive value, and negative predictive value of TET and routine ECG in diagnosing CHD were compared and analyzed. Related indexes of TET examination were compared between CHD and non-CHD patients. Results  All 91 patients with suspected CHD successfully completed CAG, and 60 cases (65.93%) were confirmed as CHD, including 38 cases with single-vessel disease and 22 cases with multivessel disease. Among the 31 patients without CHD, there were 13 cases of costochondritis, 14 cases of intercostal neuralgia, and 4 cases of esophagitis. The consistency between TET and CAG results (Kappa=0.827) was significantly higher than that between routine ECG and CAG results (Kappa=0.518, P<0.05). The sensitivity (95.00%), accuracy rate (92.31%), and negative predictive value (90.00%) of TET in diagnosing CHD were also significantly higher than those of routine ECG (81.67%, 78.02% and 66.67%, respectively; all P<0.05). During TET, exercise duration was significantly shorter, and the amount of exercise and maximal heart rate were significantly lower in CHD patients than those in non-CHD patients (all P<0.001). Conclusion  Compared with routine ECG, TET has higher sensitivity and accuracy rate in diagnosing CHD, and its results show better consistency with CAG.

Objective  To analyze the effects of endovascular stent implantation in patients with ischemic cerebrovascular disease on their cognitive function, carotid artery stenosis degree and inflammatory cytokine levels. Methods  A total of 92 patients with ischemic cerebrovascular disease were randomly divided into a control group and a stent group using the random number table method, with 46 cases in each group. The control group received conventional drug therapy, while the stent group received endovascular stent implantation on the basis of drug therapy. Cognitive function, carotid ultrasound findings, and inflammatory cytokine levels were compared between the two groups before and after treatment; the incidence of adverse reactions within 3 months after treatment was also statistically analyzed. Results  After treatment, the mini-mental state examination score in the stent group was significantly higher than that in the control group (P<0.05), while the degree of carotid artery stenosis, peak systolic velocity, end-diastolic velocity, internal carotid artery to common carotid artery peak systolic velocity ratio, levels of interleukin-6, C-reactive protein, pentraxin 3 and neuron-specific enolase, as well as the overall incidence of adverse reactions, were all significantly lower in the stent group than those in the control group (all P<0.05). Conclusion  On the basis of conventional drug therapy, endovascular stent implantation in patients with ischemic cerebrovascular disease is more effective in alleviating cognitive impairment, reducing carotid artery stenosis degree and inflammatory response, and significantly decreasing the risk of adverse reactions.

Objective  To investigate the expression of type Ⅳ collagen alpha 1 chain (COL4A1) in early-onset colorectal cancer (EOCRC) and its association with clinicopathological features. Methods  The expression, biological roles, and prognostic significance of COL4A1 in EOCRC were analyzed using databases including GEO, GEPIA and LinkedOmics. Immunohistochemical staining was performed on 43 EOCRC samples to detect COL4A1 protein expression; the relationship between COL4A1 protein expression and clinicopathological features was analyzed. Results  Bioinformatics analysis revealed that COL4A1 was highly expressed in EOCRC tissues. COL4A1 expression level was negatively correlated with Th17 cell infiltration abundance (P<0.001), and positively correlated with the infiltration abundance of T cell, macrophage, natural killer cell, neutrophil and dendritic cell (all P<0.05). Immunohistochemical staining results demonstrated positive expression of the COL4A1 protein in EOCRC tissues; the protein expression of COL4A1 in EOCRC correlated with distant metastasis and depth of infiltration (P<0.05), but there was no correlation with clinicopathological parameters such as sex, tumor location, clinical stage, lymph node metastasis, gross tumor type, differentiation degree,or underlying diseases (all P>0.05). Additionally, COL4A1 expression level was positively correlated with p53 mutation rate (P<0.05). Conclusion  COL4A1 is highly expressed in EOCRC, and is associated with distant metastasis and depth of infiltration, suggesting its potential involvement in the invasion and metastasis of EOCRC. COL4A1 may serve as a potential novel therapeutic target for EOCRC in the future.

Objective  To investigate the therapeutic effect of the combined regimen of Bifidobacterium quadruple viable tablets and phototherapy on neonatal hyperbilirubinemia. Methods  A total of 70 neonates with hyperbilirubinemia were enrolled. Random sequences were generated using the random number table method, and concealed grouping was performed. The phototherapy group (n=35) received phototherapy alone, while the combination group (n=35) received Bifidobacterium quadruple viable tablets plus phototherapy. The overall effective rate, recovery course, bilirubin levels and gut microbiota parameters before and after treatment, and adverse reactions were compared between the two groups. Results  The overall effective rate in the combination group was significantly higher than that in the phototherapy group (97.14% vs. 77.14%; χ2=6.248, P<0.05). There was no statistically significant difference in bilirubin levels between the two groups before treatment (P>0.05); after treatment, the bilirubin levels in the combination group were significantly lower than those in the phototherapy group (P<0.001). Regarding the recovery course, the combination group had significantly shorter phototherapy duration, jaundice resolution time, and hospital stay compared with the phototherapy group (all P<0.05). Before treatment, no statistically significant differences were observed in gut microbiota parameters between the two groups (all P>0.05); after treatment, the combination group showed significantly higher counts of fecal Bifidobacterium and Lactobacillus acidophilus, and a significantly lower count of Escherichia coli (all P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups during treatment (P>0.05). Conclusion  The combined regimen of Bifidobacterium quadruple viable tablets and phototherapy has a significant therapeutic effect on neonatal hyperbilirubinemia, which can accelerate recovery course, regulate the intestinal microbiota with high safety.

Objective  To investigate the clinical efficacy of N-acetylcysteine as an adjunctive therapy in elderly patients with newly treated pulmonary tuberculosis. Methods  A total of 80 elderly patients with newly treated pulmonary tuberculosis admitted to the Sixth People’s Hospital of Xinjiang Uygur Autonomous Region were enrolled. Using the random number table method, they were divided into a control group and an observation group, with 40 cases in each group. The control group received conventional anti-tuberculosis therapy, while the observation group received N-acetylcysteine on the basis of the above treatment. The overall effective rate was compared between the two groups, and the changes in inflammatory cytokines and T lymphocyte subset indicators before and after treatment were analyzed. Results  The overall effective rate in the observation group was significantly higher than that in the control group (P<0.05). After treatment, the observation group showed significantly lower levels of inflammatory cytokines including PCT, INF-γ and IL-4 (all P<0.001). Regarding blood gas analysis parameters, the observation group had lower PaCO2 and higher PaO2 after treatment (both P<0.001). In terms of T lymphocyte subgroup indicators, the observation group had higher proportions of CD3+ and CD4+, and a lower proportion of CD8+ after treatment (all P<0.001). Conclusion  N-acetylcysteine as an adjunctive therapy demonstrates definite efficacy in elderly patients with newly treated pulmonary tuberculosis. It can significantly reduce inflammatory cytokine levels, improve pulmonary ventilation function, and regulate T lymphocyte subset, exhibiting good clinical application value.

Objective  To explore the application value of a dedicated lithotomy leg holder for digital subtraction angiography (DSA) table (patent number: ZL 202120535691.0) in hysterosalpingography and tubal recanalization, and to analyze its impact on image quality and the frequency of position adjustments. Methods  Sixty patients undergoing hysterosalpingography or tubal recanalization were randomly divided into a dedicated leg holder group (n=30, using the dedicated lithotomy leg holder for DSA table) and a control group (n=30, using conventional lithotomy position: legs apart with feet on the bed board and secured with straps) by using the random number table method. The image quality scores and the number of intraoperative position adjustments were compared between the two groups. Results  The image quality score was significantly higher in the dedicated leg holder group than that in the control group ［(4.6±0.5) points vs. (3.2±0.8) points; t=7.32, P<0.01］; among them, 25 patients (83.3%) in the dedicated leg holder group achieved a maximum score of 5 points (clear visualization of the entire fallopian tubes without artifacts), while only 8 patients (26.7%) in the control group achieved a maximum score (χ2=19.46, P<0.01). The number of intraoperative position adjustments was significantly lower in the dedicated leg holder group than that in the control group ［(0.3±0.5) times vs. (2.1±1.2) times; t=8.14, P<0.01］. Conclusion  The dedicated lithotomy leg holder for DSA table can significantly improve the image quality of hysterosalpingography, reduce the need for intraoperative position adjustments, decrease patient radiation exposure, and improve patient comfort and surgical efficiency, which holds promising clinical application prospects.

Atrial fibrillation/flutter complicated by third-degree atrioventricular block is a high-risk mixed arrhythmia, in which atrial electrical activity completely fails to conduct down the ventricle, and the ventricle is controlled by lower pacemakers, usually requiring permanent pacemaker implantation. Due to the complexity of atrial fibrillation rhythm itself, such electrocardiographic manifestations are often atypical, especially transient or intermittent high-grade block, which is extremely prone to being missed in routine electrocardiograms. Ambulatory electrocardiography, through long-term continuous monitoring, provides a critical means for capturing occult and intermittent electrocardiographic abnormalities. Based on 30 such patients admitted to our department, this article summarizes our experience in diagnosis and differential diagnosis, with the aim of providing clinical reference.

Through analysis of typical cases, this article examines the electrocardiographic features of Wellens syndrome, de Winter syndrome, Aslanger sign, South African flag sign, and other electrocardiogram (ECG) manifestations in acute coronary syndrome (ACS) to enable rapid analysis and diagnosis of ACS. It also identifies the culprit vessel location, extent of myocardial infarction, and severity of myocardial ischemia. This article analyzes these special electrocardiographic features and their clinical significance in the above ACS cases, aiming to draw awareness among clinicians and ECG specialists. By thoroughly understanding these distinctive ECG patterns, we seek to increase timely diagnosis and treatment rates, accurately assess the prognosis, and prevent severe outcomes resulting from missed diagnosis and misdiagnosis.

Objective  To investigate the clinical characteristics and genetic etiology of a patient with hyperlipoproteinemia, assist in clinical genetic counseling and precise diagnosis, and further enhance clinicians’ overall understanding of hyperlipoproteinemia. Methods  Clinical indicators of the patient were followed up, and peripheral blood samples from the patient and his family members were collected for testing of lipid-related clinical indicators. Whole-exome high-throughput sequencing and Sanger sequencing were used to identify the mutation site and familial inheritance characteristics. The Alphafold online tool was employed to predict the structural model of the glycosylphosphatidylinositol-anchored high-density lipoprotein binding protein 1 (GPIHBP1), enabling a multi-perspective summary of the clinical features of this disorder. Results  Whole-exome sequencing combined with Sanger sequencing confirmed a c.239C>A:p.T80K mutation in exon 3 of the GPIHBP1 gene. Three-dimensional protein modeling revealed a spatial blocking effect between the c.239C>A:p.T80K mutation and residue p.Y66, affecting the function of GPIHBP1 protein. Variant site detection system indicated that this mutation is a pathogenic mutation associated with hyperlipoproteinemia, an autosomal recessive genetic disease. Conclusion  The proband carried a variant in exon 3 of the GPIHBP1 gene, leading to hyperlipoproteinemia. The c.239C>A:p.T80K mutation is a rare mutation form. These findings provide an important reference for the diagnosis and treatment of hyperlipoproteinemia, and further expand the understanding of the etiology of this disease.

Objective  To explore the effect of nursing intervention based on the stress system theory on patients with choledocholithiasis during perioperative period of endoscopic retrograde cholangiopancreatography (ERCP). Methods  A total of 100 patients with choledocholithiasis who underwent ERCP treatment were enrolled, and randomly assigned to an observation group and a control group, each with 50 cases, by using the random number table method. The control group received routine perioperative nursing care. In addition to routine care, the observation group received a stress system theory-based nursing intervention, which included stressor assessment and individualized intervention, cognitive intervention, psychological intervention, dietary guidance, quality control, and social support intervention. Clinical outcomes were compared between the two groups before and after the intervention, including stress responses ［evaluated via the stress response questionnaire (SRQ)］, psychological status ［assessed using the self-perception burden scale (SPBS) and the Connor-Davidson resilience scale (CD-RISC)］, illness uncertainty ［measured by the Mishel uncertainty in illness scale-adult (MUIS-A)］, disease cognition level (assessed via a self-designed perioperative knowledge questionnaire for choledocholithiasis), and nursing satisfaction. Results  After the intervention, the observation group demonstrated significantly greater improvements than the control group in SRQ scores for somatic, behavioral and emotional responses (all P<0.01), SPBS scores (P<0.001), and CD-RISC scores (P<0.05). Additionally, scores for ambiguity, lack of information, and unpredictability in the MUIS-A scale were significantly higher in the observation group (P<0.01 and P<0.05). Furthermore, all dimension scores of disease cognition and the overall nursing satisfaction rate were all significantly higher in the observation group compared with the control group (all P<0.05). Conclusion  A stress system theory-based nursing intervention can effectively alleviate perioperative stress responses in patients with choledocholithiasis undergoing ERCP. It can improve psychological state, reduce illness uncertainty, enhance disease cognition and nursing satisfaction, and ultimately promote both physical and mental postoperative recovery.

Objective  To explore the intervention effect of narrative therapy on mild anxiety in elderly patients with coronary heart disease (CHD) in wards of community health service center. Methods  A total of 76 elderly CHD patients with mild anxiety were selected, and divided into a study group (38 cases) and a control group (38 cases) using the random number table method. The control group received routine nursing care, while the study group received an 8-week narrative therapy intervention on the basis of routine nursing care. Assessments were conducted before intervention, and at 4 and 8 weeks after intervention using the self-rating anxiety scale (SAS) and the European organization for research and treatment of cancer quality of life questionnaire-core 30 (EORTC QLQ-C30). The two groups were compared in terms of anxiety level and quality of life, while the overall response rate was observed after intervention. Results  After 4 and 8 weeks of intervention, 3 cases dropped out from the study group; the SAS scores in the study group were (51.63±2.00) and (49.43±1.79) points, respectively, significantly lower than those in the control group ［(55.66±2.46) and (55.92±2.38) points, all P<0.001］. The scores of all dimensions of the EORTC QLQ-C30 in the study group were significantly better than those in the control group (all P<0.001). After 8 weeks of intervention, the overall response rate in the study group was 94.29%, significantly higher than that in the control group (76.32%, P<0.05). Conclusion  Narrative therapy can effectively alleviate mild anxiety and improve quality of life in elderly CHD patients in wards of community health service center, and the intervention effect strengthens over time.

Objective  To investigate the effect of evidence-based early-warning anesthesia nursing on postoperative recovery and complications in elderly patients undergoing general anesthesia surgery. Methods  A retrospective study was conducted. A total of 52 elderly patients undergoing general anesthesia surgery who received routine anesthesia nursing from February 2024 to January 2025 were enrolled as a control group, while another 52 elderly patients who received evidence-based early-warning anesthesia nursing from February 2025 to January 2026 were enrolled as an observation group. Postoperative awakening conditions, agitation at different time points (immediately after awakening, as well as at 1 hour, 6 hours and 12 hours after awakening) assessed by the Richmond agitation-sedation scale (RASS) scores, postoperative recovery quality assessed by the Chinese version of the 40-item quality of recovery questionnaire (QoR-40) scores, and the occurrence of complications during the recovery period from anesthesia were statistically analyzed and compared between the two groups. Results  After intervention, the time to awakening, time to tracheal extubation, and time to discharge from the post-anesthesia care unit in the observation group were all significantly shorter than those in the control group (all P<0.05). In both groups, RASS scores at 1 hour, 6 hours and 12 hours after awakening were all lower than those immediately after awakening, showing a decreasing trend; there were statistically significant differences between the two groups in terms of time points and group comparisons (P<0.05). At 24 hours postoperatively, the observation group had significantly higher scores compared with the control group in emotional state, pain, physical comfort, psychological support, and physical independence, as well as in the total QoR-40 score (all P<0.05). During the anesthesia recovery period, the incidence of complications in the observation group was significantly lower than that in the control group ［5.77% (3/52) vs. 21.15%(11/52)］, with a statistically significant difference (P<0.05). Conclusion  Evidence-based early-warning anesthesia nursing can effectively shorten the postoperative awakening time, improve the quality of recovery, and reduce the risk of complications in elderly patients undergoing general anesthesia surgery.

Objective  To investigate the effect of a safety management model-based health management for elderly patients with chronic diseases, and to provide practical reference for optimizing chronic disease management process and strengthening medical safety management in hospitals. Methods  A non-randomized controlled design was adopted. We enrolled 120 elderly patients with chronic diseases, who were admitted to Zhenjiang 359 Hospital and included in chronic disease follow-up management after discharge. Patients were divided into a control group and an intervention group according to the order of enrollment, with 60 cases in each group. The control group received routine nursing guidance; on this basis, the intervention group aditionally received a safety management model centered on risk prevention and control, which incorporated measures such as forward-shifted risk assessment, standardized procedures, stratified management, and continuous monitoring to deliver systematic nursing guidance. The two groups were compared in terms of health knowledge mastery rate, self-management ability score, incidence of adverse events, and patient satisfaction. Results  After six months of intervention, the intervention group showed a significantly higher overall health knowledge mastery rate (85.0% vs. 65.0%), a higher total self-management ability score ［(89.5±9.6) points vs. (77.1±10.2) points］, a lower overall incidence of adverse events (8.3% vs. 28.3%), and a higher overall satisfaction rate (93.3% vs. 76.7%) compared with the control group, with all differences being statistically significant (all P<0.05). Conclusion  The safety management model-based health management for elderly patients with chronic diseases can effectively improve patients’ health knowledge level and self-management ability, reduce the incidence of adverse events, and enhance patient satisfaction. It represents an effective approach for hospitals to promote refined chronic disease management and strengthen medical safety management.

Objective  To explore the effect of a nutritional requirement management program based on the health literacy stratification model in patients after gastric cancer surgery. Methods  A total of 102 patients undergoing gastrectomy were selected by convenience sampling, and randomly divided into a control group and an observation group, with 51 cases in each group. The control group received routine postoperative nursing management and dietary guidance, while the observation group implemented a nutritional requirement management program based on the health literacy stratification model on the basis of the control group, both with an intervention period of 3 months. The levels of hemoglobin, total protein, albumin and body mass index, and patient-generated subjective global assessment (PG-SGA) assessment were compared between the two groups before and after intervention. Postoperative hospital stay and the incidence rate of postoperative complications were also compared between the two groups. Results  After intervention, the levels of hemoglobin, total protein and albumin, and body mass index in the observation group were all significantly higher than those in the control group (all P<0.001). All nutritional indicators in the observation group increased compared with baseline, with a statistically significant difference in hemoglobin level before and after intervention (P<0.05). After intervention, the PG-SGA assessment in the control group showed grade A, B, and C in 33.33% (17/51), 43.14% (22/51), and 23.53% (12/51) of patients, respectively; while in the observation group, grade A, B, and C accounted for 52.94% (27/51), 41.18% (21/51), and 5.88% (3/51), respectively. The PG-SGA assessment in the observation group was significantly better than that in the control group (P<0.05). The overall incidence of postoperative complications in the control group was significantly lower than that in the control group (9.80% vs. 27.45%, P<0.05). Conclusion  The nutritional requirement management program based on the health literacy stratification model can effectively improve the nutritional status of postoperative gastric cancer patients, and reduce the overall incidence of postoperative complications.

Objective  To retrospectively analyze the application effect of a nursing model based on the concept of early comfort using analgesia, minimal sedatives and maximal humane care(eCASH) in patients with chronic obstructive pulmonary disease (COPD) complicating type Ⅱ respiratory failure. Methods  A total of 97 patients with COPD complicated by type Ⅱ respiratory failure in our hospital were selected as study subjects, and divided into a control group (49 cases) and an observation group (48 cases) according to different nursing protocols. The control group received routine nursing intervention, while the observation group received an eCASH-based nursing intervention in addition to the routine care. The incidence of delirium, rehabilitation progress (duration of mechanical ventilation, length of stay and time to recovery of independent activity), comfort level ［Kolcaba general comfort questionnaire (GCQ)］, and sleep quality ［Richards-Campbell sleep questionnaire (RCSQ)］ were compared between the two groups. Results  Compared with the control group, the observation group had a significantly lower incidence of delirium, significantly shorter durations of mechanical ventilation, length of stay, and time to recovery of independent activity, and significantly higher scores of RCSQ and GCQ (all P<0.05). Conclusion  The nurse-led intervention based on the eCASH concept can improve comfort level, reduce the incidence of delirium, accelerate rehabilitation progress, and improve sleep quality in patients with COPD complicated by type Ⅱ respiratory failure.

Objective  To investigate the current status of cardiac point-of-care ultrasound (cPOCUS) training in cardiovascular postgraduate medical education, identify barriers to its implementation, and to provide a basis for formulating standardized teaching protocols combining with trainees’ training needs at the postgraduate education stage. Methods  A multicenter cross-sectional survey was conducted from October to December 2025. Questionnaires were distributed to cardiovascular postgraduate students and junior physicians who were currently undergoing or had completed postgraduate education across 16 teaching hospitals nationwide. A total of 101 valid responses were collected. Respondents’ baseline information, theoretical knowledge of cPOCUS, practical operation and abnormal image recognition skills, clinical usage frequency, training experience, teaching resources, and training needs were statistically analyzed. Results  Over 90% of respondents considered cPOCUS an essential clinical skill for cardiologists, and 66.3% frequently relied on cPOCUS assessment in clinical practice. However, their overall competency in theory, practical operation, and image interpretation was weak: 46.5% of respondents had no experience in cPOCUS operation, and 24.8% were completely unable to identify abnormal images. Among respondents, 70.3% had received less than 5 hours of cumulative training or had no related learning experience at all, while 51.5% had never received cPOCUS-specific training. Fragmented bedside teaching and self-study were the main learning approaches. Among the respondents, 74.3% preferred systematic courses that integrate theory and practical operation, however 57.4% tended to a “self-study of theory plus beside teaching” approach. Shortage of training resources and clinical workload competing for learning time were cited as the main factors hindering skills training. Conclusion  Cardiovascular postgraduate students and junior physicians have strong needs for cPOCUS learning at the postgraduate education stage, however the standardized training system and teaching resources remain to be improved. The training models that combine theory and practice, and suit different training stages should be explored in the future. It is also necessary to improve the construction of teaching staff, supplement the supply of teaching equipments, so as to enhance young physicians’ proficiency in cPOCUS operation and image interpretation.

Sudden cardiac death (SCD) is one of the leading causes of death worldwide, accounting for approximately 50% of cardiovascular disease-related deaths. Its occurrence is closely associated with the “Bermuda Triangle” of SCD consisting of cardiac structural abnormalities, electrophysiological disorders, and internal environment imbalance. This review systematically summarizes three primary etiologies: organic heart disease, primary cardiac electrical disorders, and internal environment-related factors. It elaborates the research advances in multidimensional risk prediction encompassing spatiotemporal, characteristic, model and scenario dimensions, analyzes the core problems existing in current multidimensional prediction systems, and looks forward to development directions such as multimodal data integration and artificial intelligence-assisted assessment. The aim is to provide reference for early identification, precise risk stratification, and individualized management of SCD, thereby enhancing the specificity and effectiveness of SCD prevention and control, and reducing the incidence rate of SCD.