Objective： To preliminarily elucidate the molecular mechanism of Codonopsis pilosula in the treatment of immune thrombocytopenia （ITP） through network pharmacology，differential gene analysis，and molecular docking. Methods： The main components and corresponding protein targets of Codonopsis pilosula were searched in the TCMSP，TCMID and ETCM.The targets of ITP were collected from the GeneCards，OMIM，and DisGeNET databases.A Venn diagram was constructed to obtain the intersection targets between the compound targets and disease targets，and the qualified targets were imported into the STRING database.The PPI network was constructed using Cytoscape 3.9.1.Subsequently，GO and KEGG enrichment analyses were performed on the intersection targets to explore the relevant signaling pathways of ITP and Codonopsis pilosula.Finally，molecular docking studies were conducted on the key targets and active compounds. Results： A total of 84 potential active compounds，2 354 ITP related targets，257 interaction targets，and 86 intersection targets of Codonopsis pilosula were collected.Through PPI network analysis，15 key targets were identified， with the top five targets ranked by Degree values including VEGFA，SRC，IL2，PPARG，and EGFR.GO and KEGG analyses indicated that Codonopsis's treatment of ITP mainly involves biological processes such as positive regulation of the ERK1 and ERK2 cascade，signal transduction，and protein phosphorylation.The signaling pathways mainly include the PI3K⁃AKT，cancer， and T⁃cell signaling pathways.Molecular docking results showed that SRC and PPARG exhibited high binding activity with 1⁃hydroxyrankinidine.Myristic acid，ethyl α⁃d⁃fructofuranoside，and glycitein are important active compounds and were verified through molecular docking simulations. Conclusion： This study clarifies from multiple perspectives that Codonopsis pilosula may exert therapeutic effects on ITP by regulating multiple targets and pathways，providing a scientific basis for further investigating the effects of Codonopsis pilosula on ITP.

Objective： To investigate the prevalence and characteristics of depression at different stages of pregnancy in Southwest China. Methods： This study was a prospective multicenter study， and the research time was from March 2018 to May 2019.The pregnant women who were diagnosed with pregnancy and underwent systematic prenatal examination in 4 obstetrics and gynecology hospitals at different levels （ministerial， provincial， municipal and district） in Chengdu of China were selected as the research objects using stratified sampling and convenient sampling.The Edinburgh Postnatal Depression Scale and self-designed general questionnaire were used to investigate the pregnant women in the first，second and third trimesters of pregnancy， and the influencing factors of pregnancy depression were analyzed. Results： A total of 1 051 pregnant women completed the whole study.Among them，346（32.92%） had depression in the first trimester，208 （19.79%） in the second trimester and 215（20.46%） in the third trimester.77（7.33%） had depression in three consecutive periods，135（12.84%） had depression in any two periods，268（25.50%） had depression in any one period， and 571（54.33%） had no depression.Compared with the non-depression group，the relationship with parents-in-law，the relationship between husband and wife，the occurrence of major events at home， the worry about dystocia and taking care of children by themselves were the independent influencing factors of the continuous depression group （<0.05）.Compared with the depression group of any one stage，the relationship between husband and wife， major events at home，fear of dystocia and spouse's expectation of fetal gender （male） were independent influencing factors of the continuous depression group（<0.05）.Compared with the depression group of any two stages， the spouse's expectation of sex for the fetus （male） was an independent factor for the continuous depression group（P<0.05）. Conclusion： Depression occurs in all trimesters of pregnancy.Compared with the second and third trimesters，the incidence and severity of depression in the first trimester are the highest. Attention should be paid to the psychological status of pregnant women in early pregnancy，and psychological screening and intervention should be carried out from early pregnancy.For women with continuous depression during pregnancy， we should help them establish a good relationship with husband，encourage pregnant women to build up confidence in childbirth，and guide spouses to hold a correct attitude towards the gender of their children，so as to improve their depression status and promote the health of mothers and children.

Objective： To investigate the uncertain stress of the solidarity elderly and the non- solidarity elderly in Zhejiang province， and to analyze the influencing factors of the uncertain stress. Methods： A total of 173 solidarity elderly and 957 non⁃solidarity elderly in Zhejiang provincewere recruited by multi⁃stage random sampling.They were investigated by the general information questionnaire and uncertainty stress questionnaire. Results： The score of uncertain stress among the solidarity elderly were significantly higher than the non- solidarity elderly［（22.50±8.34） vs （21.56±7.85），<0.05］.Multiple linear regression showed that monthly household income per person，relations with descendant， availability of community⁃based services，and knowledge of first aid methods were factors affecting uncertain stress among the solidarity elderly. Marital status，monthly household income per person， relationship status with descendant， knowledge of first aid methods， self-rated health status and nearly 1⁃year history of unexpected fall were predictors of uncertain stress among the non⁃solidarity elderly. Conclusion： The prevalence of uncertain stress the elderly is relatively high in Zhejiang province，with a higher uncertain stress level in the solidarity elderly.It is suggested that the financial support for the solidarity elderly should be increased，and the descendant should care more for their parents， and the community should provide more services for the elderly，so as to alleviate the current situation of high uncertain stress of the elderly.

Objective： To investigate status quo of knowledge，attitude，and practice of sports and medicine integration in the elderly， and to explore its influencing factors. Method： From July to December 2022，a total of 406 elderly people in Tianjin were investigated with the self⁃made general information questionnaire and the knowledge，attitude and practice questionnaire for the elderly with physical and medical integration. Result： The standard score of 406 elderly was 53.8.The standard scores of knowledge，attitude and behavior were 49.2，75.6 and 38.0 respectively.The economic level，life satisfaction and health status of the elderly in the community were the influencing factors of knowledge，attitude and practice of medical integration （<0.05）. Conclusion： The knowledge，attitude and practice level of physical medical integration of the elderly in Tianjin needs to be improved.We should improve the publicity and development programs of physical medical integration based on the actual needs of the elderly，provide channels and programs for the elderly with different characteristics to recognize and practice physical medical integration，and promote the long⁃term and benign development of physical medical integration in China.

Objective： To investigate the types， composition， and dynamics of symptom clusters experienced by patients with esophageal cancer in the perioperative period，and to provide theoretical guidance for symptom management in patients with esophageal cancer. Methods： A total of 161 patients who underwent radical esophageal cancer surgery for the first time in the Department of Thoracic Surgery in a tertiary care hospital in Nanchong City from March 2022 to September were conveniently selected and longitudinally surveyed using a self⁃administered general information questionnaire and the Esophageal Cancer Perioperative Symptom Assessment Scale 1~3 days before surgery （T1），1~3 days after surgery （T2） and 1~3 days before discharge （T3），and symptom clusters were identified by exploratory factor analysis. Results： A final total of 154 patients were included. Patients had different incidences and severity of symptoms at the 3-time points.Exploratory factor analysis extracted three symptom clusters of eating⁃related symptom cluster， psychological symptom cluster，and energy deficit symptom cluster in T1； four symptom clusters of eating⁃related symptom cluster， psychological symptom cluster，energy deficit symptom cluster， and pain⁃fatigue symptom cluster in T2；three symptom clusters of eating⁃related symptom cluster，somato⁃psychological symptom cluster， and pain⁃fatigue symptom cluster in T3，among which the eating⁃related symptom cluster was stable in the perioperative period and was specific to patients with esophageal cancer. Conclusion： There is a stable and dynamic symptom cluster during the perioperative period in patients with esophageal cancer.Patients' symptoms should be assessed， symptom management implemented promptly， and a targeted intervention plan should be developed to reduce the impact of surgery⁃related symptoms on patients.

Objective： To establish a predictive model of pressure injury （PI） in intensive care unit （ICU） patients by combining limb muscle strength and transcutaneous oxygen pressure （TcPO） with clinical data. Methods： 429 patients admitted to the ICU of our hospital from April 2021 to January 2023 were retrospectively selected as the research objects.The patients were divided into a training set （=299） and a test set （=130） according to the ratio of 7∶3 by random sampling.Logistic regression model was used to analyze the influencing factors of pressure injury in patients，and random forest algorithm was used to construct a random forest model.The area under the receiver operating characteristic （ROC） curve，sensitivity，and specificity were used to evaluate the predictive efficacy of the two models. Results： 71 cases occurred pressure injury among 299 patients in the training set， with an incidence of 23.75%.Multivariate analysis showed that diabetes mellitus，APACHE⁃Ⅱ score， Braden score，TcPO，limb muscle strength， mechanical ventilation，and use of vasoactive drugs were the influencing factors of PI in ICU patients （<0.05）.The order of importance of predictors in the random forest model was TcPO，APACHE⁃Ⅱ score，limb muscle strength，Braden score，mechanical ventilation，use of vasoactive drugs，and combination of diabetes. The test set was introduced to verify the prediction efficiency of the two models. It was found that the area under the ROC curve of the logistic regression model was 0.871， the sensitivity was 84.5%，and the specificity was 81.4%.The area under the ROC curve of the random forest model was 0.912， the sensitivity was 88.5%，and the specificity was 84.2%. Conclusions： TcPO， APACHE⁃Ⅱ score， limb muscle strength，Braden score， mechanical ventilation，use of vasoactive drugs， and combination of diabetes were the influencing factors of PI risk in ICU patients. Furthermore， the predictive performance of the random forest model for PI risk in ICU patients was better than that of the Logistic regression model.

Objective： To explore the relationship between self⁃care ability and mental resilience of elderly people with home disability and their caregivers based on the actor⁃partner interdependence model. Methods： The home⁃disabled elders and their family caregivers were investigated by using a general demographic data questionnaire， Self⁃care Ability Assessment Scale （ASAS⁃R⁃C）， Family Care Ability Scale（FCTI⁃25）， and Mental Resilience Scale （CD⁃RISC⁃10）. Based on the actor⁃partner interdependence model， the relationship between the self⁃care ability and mental resilience of home⁃disabled elders and their caregivers was analyzed. Results： The total score of the self-care ability of the home⁃disabled elders was （51.76±7.75）， and the total score of caregivers' care ability was （39.70±7.19）.The difference was significant （=-13.722，<0.05）.The total score of mental resilience of the home-disabled elders was （34.59±7.19）， and that of the caregivers was （37.79±5.92），and the difference between them was significant （=-5.036， <0.05）.The self⁃care ability of the home⁃disabled elders and the care ability of their caregivers were positively correlated with their own and their partner's mental resilience scores （=0.287⁃0.571，<0.05）.The self⁃care ability of the home disabled elders and their caregivers can positively affect their mental resilience （＝0.528，0.228，<0.01），which suggested that the actor effect was significant. The mental resilience of disabled elderly was only affected by their self-care ability（=0.109， >0.05）， while the mental resilience of caregivers was affected by both their self⁃care ability and the self⁃care ability of disabled elderly（=0.196，<0.05），it suggested that only caregivers' partner⁃effect was significant. Conclusion： The self⁃care ability of the elderly with home disability and their caregivers' caring ability interact with their mental resilience. The mental resilience of the elderly is only affected by their caring ability， but the mental resilience of the caregivers is affected by themselves and their partners. Medical staff can regard disabled elderly people and caregivers as a common unit to develop a dual training strategy of caring ability， encourage disabled elderly people to participate more in their care work， start from practical problems in daily life，guide caregivers to better adapt to the role of caregivers， to improve their mental resilience in dealing with long⁃term care.

Objective： To explore the potential categories of resilience in gastric cancer patients undergoing chemotherapy and to analyze the factors influencing different potential categories based on Kumpfer's resilience framework（KRF）. Methods： Totally 265 patients undergoing chemotherapy for gastric cancer in the oncology department of a tertiary grade A hospital in Jiangsu province from December 2021 to November 2022 were surveyed using the General Information Questionnaire，Connor and Davidson's Resilience Scale （CD⁃RISC），Fear of Disease Progression Simplified Scale （FoP⁃Q⁃SF），General Self-Efficacy Scale （GSES），Medical Coping Style Scale （MCMQ），and Social Support Rating Scale （SSRS）.Latent Profile analysis（LPA）was used to explore the potential categories of resilience among gastric cancer patients undergoing chemotherapy. Single-factor analysis， analysis of variance，and multinomial logistic regression analysis were used to identify the factors associated with the potential categories of resilience. Results： The LPA divided the resilience of gastric cancer chemotherapy patients into 4 potential categories， namely， low resilience group （17.7%），medium resilience group （47.6%），medium⁃high resilience group （26.8%）， and high resilience⁃volatility group （7.9%）. Multiple logistic regression analysis revealed fear of disease progression，self⁃efficacy， coping style（confrontation dimension， submission dimension），and social support as influencing factors for potential categories of resilience （<0.05）. Conclusion： The resilience of patients undergoing chemotherapy for gastric cancer is characterized by distinct categories. Healthcare professionals should develop targeted and personalized care measures according to the characteristics and influencing factors of their different potential categories to improve the level of mental resilience of patients.

Objective： To explore the trajectory of somatic symptoms at different time points in elderly patients with heart failure and the selection of the best intervention time point. Methods： From September 2021 to December 2021，a convenient sampling method was used to select 310 elderly patients with heart failure from a tertiary grade A cardiovascular hospital in Henan province as the study subjects.They were investigated using the general information questionnaire and the Heart Failure Symptom Assessment Scale （HF⁃MSAS） on the day of discharge （T1） and at 1，3，6，9，12 months after discharge （T2⁃T6）， respectively.Latent variable growth mixed model （LCGM） was used to identify the change trajectory of the physical symptom group in elderly patients with heart failure at six time points. Results： 216 patients conducted the follow⁃up.Exploratory factor analysis both extracted rest⁃related symptom groups and digestive tract⁃related symptom groups at 6 time points. The rest related symptom group was fitted by LCGM to obtain "first ascending then descending group" and "first ascending then descending stable group".The relevant symptoms of the digestive tract were fitted to obtain "first rising then falling group""first rising then falling rising group""first rising then falling stable group". Conclusion： The physical symptoms of elderly patients with heart failure have different trajectory characteristics， and intervention time points can be selected based on the trajectory characteristics or targeted at patients with an upward trend in subgroup trajectory characteristics.

Objective： To analyze the application effect of nurse⁃led chest⁃lung physiotherapy （CPT） guided by lung ultrasound in patients with invasive mechanical ventilation. Method： A total of 70 adult critically ill patients with invasive mechanical ventilation time ≥ 48 h admitted to the intensive care unit （ICU） of a tertiary grade A hospital in Zunyi from June to December 2021 were selected and divided into study group （ 29 cases ） and control group （ 31 cases ） according to the random number table method.The control group was treated with conventional CPT，the study group implemented target⁃oriented CPT according to the results of lung ultrasound exploration. The lung ultrasound score，respiratory function，daily sputum volume，oxygenation index（PaO/FiO），invasive mechanical ventilation⁃related complications（VAP，atelectasis，DVT） and the incidence of adverse transport events were observed before and after intervention in the two groups.The time of invasive mechanical ventilation and the total length of stay in ICU after intervention were recorded in the two groups. Results： After excluding 10 patients，29 patients were included in the study group and 31 patients were included in the control group.The lung ultrasound scores of the two groups showed a downward trend after intervention， and the study group was lower than the control group at 3⁃7 days of intervention （<0.05）.The tidal volume of the two groups increased after intervention， and the tidal volume of the study group was higher than that of the control group （<0.05）.The peak airway pressure of the two groups after intervention was lower than that before intervention （<0.05）.The daily sputum volume of the study group was significantly higher than that of the control group （<0.05）. The oxygenation index of the two groups after intervention was improved compared with that before intervention，and the study group was higher than the control group at 3-7days after intervention （<0.05）.The time of invasive mechanical ventilation，the total length of ICU stay， the total incidence of invasive mechanical ventilation⁃related complications and transport adverse events in the study group were better than those in the control group （<0.05）. Conclusion： The implementation of nurse⁃led CPT treatment under the guidance of lung ultrasound can help patients with invasive mechanical ventilation to clear lower respiratory tract secretions，promote airway sputum excretion， improve lung ventilation function，reduce the incidence of complications related to invasive mechanical ventilation and adverse transport events， and shorten the time of invasive mechanical ventilation and ICU stay.

Objective： To explore the experience of social alienation in maintenance hemodialysis patients，and to provide reference for the development of targeted nursing intervention. Methods： Using the phenomenological research method in qualitative research，16 patients with maintenance hemodialysis were selected according to the purposive sampling method， and face⁃to⁃face and semi⁃structured interviews were conducted to collect data.Colaizzi 7⁃step analysis was used to analyze the data. Results： A total of 4 themes were summarized，which were the performance of social alienation of maintenance hemodialysis patients， multiple factors forming the social alienation of maintenance hemodialysis patients，coping style of social alienation of maintenance hemodialysis patients， and the support that maintenance hemodialysis patients hope to obtain. Conclusion： Social alienation of maintenance hemodialysis patients has characteristic manifestations，which is caused by a variety of factors，and their coping styles are diverse.It is suggested that medical staff should dynamically evaluate the status of patients，accurately identify the phenomenon of social alienation，and actively provide diversified interventions.