Objective To explore the feasibility and clinical value of endoscopic resection of duodenal papilla tumors with a maximum diameter greater than 3 cm. Methods A retrospective analysis was conducted on the clinical data of all 12 patients who underwent endoscopic resection of duodenal papilla tumors at the Endoscopy Center of Zhongshan Hospital (Xuhui Hospital), Fudan University and Rongcheng Hospital of Traditional Chinese Medicine from September 2017 to May 2023. The size of the tumors all exceeded 3 cm. Results All 12 patients successfully completed the operation, with a complete resection rate of 91.7% (11/12) and an en-bloc resection rate of 91.7% (11/12). One patient experienced delayed bleeding due to unclosed wound during operation and received endoscopic hemostasis; 11 cases underwent partial wound closure operation with pancreatic and biliary stent placement, without perforation or postoperative stenosis. Among them, 2 cases (18.2%) experienced delayed bleeding and received endoscopic hemostasis treatment. After operation, 1 case (8.3%) experienced nausea, vomiting, upper abdominal discomfort, and elevated blood amylase levels, who was later treated conservatively. During the mean follow-up period of 30.5 (1.0-69.0) months, 1 patient experienced recurrence and underwent surgical resection. Conclusions Endoscopic resection of duodenal papilla tumors can treat large diameter duodenal papilla tumors exceeding 3 cm, but postoperative complications may occur and require special attention. Postoperative placement of pancreatic and biliary stents and wound closure may reduce the incidence of complications.

Objective:To investigate the current situation of clinical practice of cancer chemotherapy-related gastrointestinal symptoms (CGIS) management among oncology nurses in Ningxia, and to explore the correlation between CGIS management and nurses′ knowledge and attitude and medical and nursing cooperation, so as to provide evidence for improving the clinical practice of cancer patients CGIS management among oncology nurses in Ningxia.Methods:This was a cross-sectional study. From January 25 to 31, 2021, the general data questionnaire and the questionnaire of clinical practice of CGIS management for cancer patients were used to survey 289 nurses in oncology department in Ningxia.Results:The scores of medical and nursing cooperation, CGIS knowledge, attitude, and CGIS management clinical practice activities of nurses in oncology department were (24.94 ± 3.20), (20.19 ± 3.82), (52.19 ± 6.17) and (129.93 ± 36.33) points, respectively. Among the scores of CGIS management clinical practice activities, gastrointestinal symptoms evaluation dimension scored the lowest, and the highest was CGIS health education dimension. There was a significant positive correlation between the scores of clinical practice of CGIS management of cancer patients and the scores of knowledge and attitude of oncology nurses ( r values were 0.225-0.293, all P<0.05). Conclusions:The clinical practice of cancer patients′CGIS management by oncology nurses needs to be improved, especially the evaluation of cancer patients′CGIS by oncology nurses. Nursing managers should formulate the activity guide of CGIS management clinical practice as soon as possible, strengthen the training of nurses′ relevant knowledge, and provide nurses with appropriate evaluation tools to improve the clinical practice of CGIS management.

Objective:To explore the status of tumor inpatients' participation in medication safety behavior, and analyze its influencing factors.Methods:From October to November 2020, convenience sampling was used to select 502 patients with malignant tumor in Peking University Cancer Hospital. A survey was carried out on the patients by using the General Information Questionnaire and the Inpatients Involvement in Patient Medication Safety Scale. Multiple stepwise regression was used to analyze the influencing factors of medication safety behaviors in tumor inpatients.Results:The total score of 502 patients' participation in medication safety behavior was (88.86±16.79) . The scoring rate of the 3 dimension items from high to low were decision-making involvement, care involvement, appealing involvement. Multiple stepwise regression showed that educational level, the importance of conscious participation in medication safety, knowledge of disease treatment, medication process and participation methods were the influencing factors for tumor inpatients' participation in medication safety behavior ( P<0.05) . Conclusions:Tumor patients' participation in medication safety behavior needs to be further improved. It is necessary to improve the patient's awareness of participating in medication safety and explore feasible ways of patient participation to improve patient participation in medication safety behavior and further promote patient medication safety.

Objective:To construct a core competency evaluation index system for ophthalmic specialist nurses so as to provide theoretical reference for cultivation and evaluation of ophthalmic specialized nurses in China.Methods:A research group was set up in October 2020, and the core competency evaluation index system for ophthalmic specialist nurses was initially formed by means of literature review, semi-structured interview and group discussion. From December 2020 to January 2021, an online questionnaire was used to conduct Delphi letter consultation among 23 experts in related fields nationwide, and the items were screened and modified. The weight of indicators was determined by the proportional distribution method.Results:Two rounds of consultation were conducted. The positive coefficients of experts were respectively 91.30% and 100.00%, Kendall's concordance coefficients were respectively 0.172 and 0. 192 ( P<0.05) , and the expert authority coefficient was 0.90. Finally, an index system consisting of 5 first-level indicators, 12 second-level indicators and 58 third-level indicators was formed. Conclusions:The core competence evaluation index system of ophthalmic specialist nurses constructed in this study has a high degree of enthusiasm and authority of experts, which reflects the characteristics of the ophthalmic nursing specialty and provides theoretical reference for cultivation and ability evaluation of ophthalmic specialist nurses in China.

OBJECTIVETo observe effects of electroacupuncture (EA) at "Weizhong" (BL 40) on morphology and expression of creatine kinase (CK) and interleukin-17 (IL-17) in rats with bupivacaine-induced multifidus muscle injury.

METHODSA total of 32 male SD rats were randomly divided into a control group, a model group, a Weizhong group and a Shenshu group, 8 rats in each one. The rats in the model group, Weizhong group and Shenshu group were treated with intramuscular injection of 0.5% bupivacaine to establish the model of multifidus muscle injury; the rats in the control group were injected with 0.9% sodium chloride solution. The rats in the Weizhong group and Shenshu group were treated with EA (2 Hz/10 Hz in frequency, 1~2 mA in intensity) at "Weizhong" (BL 40) and "Shenshu" (BL 23), 20 min per treatment. No treatment was given in the control group and model group. After 14-day treatment of EA, the inflammatory cell count, scar tissues area and muscle fiber cross sectional area of multifidus muscle were observed with HE and Masson staining method. The activity of CK and serum content of IL-17 were test with enzyme-linked immunosorbent assay (ELISA) method; the expression of IL-17 in multifidus muscle was measured with immunohistochcmical method.

RESULTSAfter intervention, the inflammatory cell count and scar tissues area in the model group, Weizhong group and Shenshu group were higher than those in the control group (all<0.01), but the muscle fiber cross sectional area was significantly reduced (all<0.01); the inflammatory cell count and scar tissues area in the Weizhong group and Shenshu group were lower than those in the model group (all<0.01), and the muscle fiber cross sectional area was significantly increased (<0.01,<0.05). After intervention, the expression of IL-17 in multifidus muscle, serum content of IL-7 and activity of CK in the model group, Weizhong group and Shenshu group were higher than those in the control group (all<0.01); the expression of IL-17 in multifidus muscle, serum content of IL-7 and activity of CK in the Weizhong group and Shenshu group were lower than those in the model group (<0.01,<0.05); compared with the Shenshu group, the down-regulation of IL-17 was more obvisous in the Weizhong group (<0.01).

CONCLUSIONEA at "Weizhong" (BL 40) can down-regulate the overexpression of serum CK and IL-17, alleviate inflammation reaction and improve the repair of multifidus muscle.

Objective To explore the value of human epididymis protein 4(HE4),cancer antigen 125(CA125) and the risk of ovarian malignancy algorithm(ROMA) in the diagnosis of ovarian cancer.Methods Electrochemical luminescence and Enzymelinked immunosorbent assay (ELISA) were used to determine the levels of serum HE4,CA125 in 56 patients with ovarian carcinoma,73 cases of ovarian benign tumor and 50 health women,and the ROMA was calculated by HE4 and CA125 levels depending on the menopause state,drawing the receiver operating characteristics(ROC) curve and calculating the area under the curve(AUC).Results The average levels of the HE4,CA125 and the value of the ROMA were (345.33±605.03)pmol/L,(701.46±1 500.30) U/mL,(58.72±31.00) ％ in the ovarian carcinoma group,(53.84± 14.68)pmol/L,(44.25±45.81)U/mL,(10.80± 6.75) ％ in the ovarian benign tumor group,and (46.03±10.26)pmol/L,(17.39±10.64)U/mL,(6.92±3.85)％ in the health control group respectively,compared with the benign tumor group and the health control group,the ovarian carcinoma group were higher in HE4,CA125 and the ROMA value,and the difference were significantly (P＜0.05),whereas compared in the ovarian benign group and the health group,except the CA125 was higher in the benign group and the difference had statistical significance(P＜0.05),the HE4 level and the value of the ROMA had no statistical significance(P＞0.05).The sensitivities of the HE4,CA125 and ROMA were 71.43％,76.79 ％,89.28％,the specificities were 93.15 ％,53.42％,94.52 ％ and the ROC-AUCs were 0.930,0.809,0.937 respectively.When the specificity for the diagnosis of the ovarian carcinoma was 95.00％,the sensitivities of the HE4,CA125 and ROMA were 80.40％,53.60％,83.90％ respectively.Conclusion HE4 and CA125 combined detection to calculate the ROMA can elevate the sensitivity and specificity for the ovarian carcinoma diagnosis.

Objective To investigate and compare the level of food specific IgG antibody between children with chronic diarrhea and healthy children,analyze the correlation between chronic persistent diarrhea and food intolerance.Methods The research objective of 105 cases was obtained from in-patient children in Shenzhen children′s hospital diagnosed as chronic persistent diarrhea and 94 cases diagnosed not diarrhea as control group in the year of 2015.The level of fourteen food allergen specific IgG in serum was detected using enzyme-linked immunosorbent (ELISA) in 199 cases.Results Chronic persistent diarrhea was more observed in 0-1 years old of infants.The positive rate of 14 food allergen specific IgG in 105 cases of children with chronic persistent diarrhea in turn from high to low was milk,eggs,tomatoes,rice,wheat,cod,corn,beef,soybeans,chicken,pork,mushrooms,shrimp and crab;14 food allergen specific IgG in 94 cases of children not with diarrhea in turn from high to low was arranged as follows:milk,eggs,tomatoes,rice,wheat,soybeans,cod,corn,beef,crab,chicken,mushroom,shrimp and pork.Among them the level of milk,beef and soybeans in the comparison of the two groups was significantly different(P<0.05).Conclusion Food intolerance was one of the important factors caused chronic persistent diarrhea in children.Reasonable diet for children may be the effective treatment of chronic persistent diarrhea.

Objective To analyze the factors and prognosis of graft recovery after donation after citizens death (DCD) donor renal transplantation.Methods A retrospective analysis of 67 cases of DCD renal transplantation from August 2012 to September 2015 in our hospital was carried out.According to the stability of renal function after operation,the patients were divided into group A (51cases) with stable renal function,and 16 cases in group B (delayed graft function after operation).The clinical data of two groups including age,gender,cause of death,warm ischemia time,type of dialysis,and application of norepinephrine before operation were collected and analyzed.The related factors of graft function recovery were analyzed.Logistic regression analysis was used to analyze the risk factors of graft functional recovery after operation.The 3-month,6-month,1-year and 18-month survival rate after operation in the two groups was compared.Results The causes of death,the time of ischemia,the type of dialysis before operation,the application of norepinephrine before operation,infants and young donors were related factors of graft function recovery (P ＜ 0.05).Logistic regression analysis showed that cerebral hemorrhage death donor,the long thermal ischemia time,the preoperative hemodialysis and the application of norepinephrine before operation were the risk factors of delayed graft function recovery (P＜0.05).The 3-month,6-month,1-year and 18-month survival rate after operation in group A was higher than that in group B,with the difference being statistically significant (P＜0.05).Conclusion Cerebral hemorrhage death donor,the long thermal ischemia time,the preoperative hemodialysis and the application of norepinephrine before operation were the independent risk factors of delayed graft function recovery.And the prognosis of patients with delayed graft function was poor.Clinical risk should be eliminated or reduced in clinical practice,which can effectively prevent the delayed graft function and further improve the prognosis of the patients.

Objective To evaluate pathogens and antimicrobial resistance of pathogens causing refractory pneumonia in children.Methods Children with refractory pneumonia who admitted to a hospital between May 2008 and December 2014 were performed bronchoscopy,and bronchoalveolar lavage fluid (BALF)were performed bacterial culture and antimicrobial resistance testing.Results 1 693 patients were recruited in the study,273 bacterial isolates were isolated from BALF speci-mens of 226 children,gram-positive bacteria accounted for 38.10% (104/273 ),the main gram-positive bacteria were Streptococcus pneumoniae (n=71)and Staphylococcus aureus (n=23);gram-negative bacteria accounted for 58.24%(159/273),including 44 isolates of Haemophilus parainfluenzae ,28 Klebsiella pneumoniae ,19 Escherichia coli ,and 17 Pseud-omonas aeruginosa ;10 isolates of fungi were also detected,8 of which were Candida albicans .The sensitivity of Streptococ-cus pneumoniae to quinolones,ceftriaxone and cefotaxime were high.Methicillin-resistant Staphylococcus aureus (MRSA) positive rate was 26.32%.ESBLs-producing rate of Haemophilus parainfluenzae and Klebsiella pneumoniae was 32.72% and 62.96% respectively.Conclusion The major pathogens causing refractory pneumonia were Streptococcus pneumoniae and Haemophilus parainfluenzae ,empirical treatment should be conducted accordingly,antimicrobial resist-ance should be considered if therapeutic effect is poor,and targeted therapy should be performed according to cultured re-sults and antimicrobial susceptibility testing result.

Objective To evaluate combined effect on different population through 2 459 data of SAA,hs-CRP and PCT from 8 three-level hospitals in Guangdong region.Methods Subjects were divided into five groups by ages,and every group had bacterial and virus type.In order to confirm diagnostic effect on infection,methods were performed including in tendency of SAA and hs-CRP,Paired t test between bacterial and virus group,efficiency of 3 indexes in judging infection depending on ROC and parameters,multiple logistic regression,consistency between positive bacterial infection and bacterial culture.Re-sults There were statistically significant differences in SAA and hs-CRP between bacterial and virus in infants and children (P <0.001).SAA had the biggest AUC area 0.824 with sensibility 71.8% and specificity 82.6% in younger group.Corre-sponding,hs-CRP had the biggest area 0.806 with sensibility 84%.There was the accuracy of 78.8% for differential diagno-sis in younger group,while 65.1% in elder group.AUC of SAA was 0.883 for positive bacterial culture with sensibility 71.2% and specificity 90.7%,accuracy of 95.2% for differential diagnosis.Conclusion There was obvious trend of age in SAA and hs-CRP,3 indexes could be used for differential diagnosis alone or combined,especially in younger group.SAA is the best index as a separated index.There is less value at ratio of SAA and hs-CRP.