Objective To explore the effect of preoperative evaluation checklist in the preoperative preparation of laparoscop‐ic cholecystectomy .Methods Based on whether the preoperative evaluation checklist was used or not ,664 cases of patients were di‐vided into control group (n=350) and experimental group (n=314) .Routine preparation was used in the control group ,while the preoperative evaluation checklist made by department of hepatobiliary surgery in the second affiliated hospital of Chongqing medical university was added to the experimental group .The case histories of patients in both groups were retrospectively reviewed ,so as to make comparisons of the defect of preoperative preparation ,influence to operation (delay or cancel) ,comprehension of preoperative knowledge ,and score of degree of satisfaction .Results The incidence rate of the defect of preoperative preparation in the experi‐mental group (1 .59% ) was lower than that in the control group (6 .86% ) with a statistical difference (P<0 .05) .The influence to operation (delay or cancel) in the experimental group was lower than that in the control group with a statistical difference (P<0 .05) .The comprehension of preoperative knowledge and score of degree of satisfaction in the experimental groups were obviously superior to those in the control groups ,which both had a statistical difference (P<0 .05) .Conclusion The application of preopera‐tive evaluation checklist in laparoscopic cholecystectomy could benefit for sufficient preoperative preparation ,conducting surgery as scheduled ,patients′comprehension of preoperative knowledge and patients′satisfaction of medical treatment ,which deserved widely clinical generalization .

Objective To construct nursing service quality evaluation index system for abdominal operation patients. Methods Based on the service quality(SERVQUAL)model, a total of 33 nursing experts were selected by Delphi method for two turns of consultation. All the consultation experts have got senior professional title and 90.9%(30/33) have been working for more than 20 years. Finally, we calculated the questionnaire response rates, the authority coefficient, the mean and standard deviation, the coefficient of variation and the harmony coefficient. Results The response rates of questionnaires was 91.89% and 100% respectively, while the authority coefficient of experts was 0.91. The harmony coefficient of first and second and third indictors was 0.43, 0.47 and 0.53 respectively in the second consultation. Combined with selection of indicators and expert opinion, the final evaluation index system includes 6 first grade indexes, 14 second grade indexes and 49 third grade indexes. Conclusions There is a high level of authority and team coordination in experts. The results of the study can provide a reference for evaluating the nursing service quality of abdominal operation patients.

The implant-supported prosthesis has gradually become the preferred treatment for patients with partial edentulous or complete edentulous. Causes for the implant failure have been discussed in the majority of studies conducted in recent years, while their risk factors are still controversial. Patient factors (gender, age, smoking, osteoporosis, diabetes, medication, periodontitis and bruxism), clinical parameters (implant area, bone quality, implant size) and doctor factors (surgical-related factors, prosthesis-related factors) will all affect implant failure. This article presents typical clinical cases and reviews the potential risk factors for dental implant failure, in order to provide guidance for clinical practice.

Objective:To explore the feasibility of fetal intelligent navigation echocardiography (FINE) in automatic quantitation of cardiac axis (CA).Methods:A total of 62 pregnant women of which 2 with twins′ pregnancy in the second and third trimesters from May to June 2020 in Sir Run Run Shaw Hospital Zhejiang University College of Medicine were enrolled in this non-selective and prospective study. After excluding those who could not be analyzed, they were assigned into four groups according to their CA measuring methods: ①Group with manual measuring CA in systole (CAS); ②Group with manual measuring CA in diastole(CAD); ③Group with CA measured by FINE in three-steps; ④Group with CA measured by FINE in seven-steps. The CAS among groups were compared in order to analyze the consistency and correlation of CAS achieved by different methods, meanwhile, the intra-observer and inter-observer consistency and repeatability were also evaluated.Results:A total of 64 fetuses with 187 volume data were collected, of which 60 cases of fetal data can be included in the study, 57 cases of normal CA, 3 cases of abnormal CA, a total of 158 volume data can be used for data analysis, the success rate was about 84.5%. Because of the small number of abnormal CA cases (3 cases), only 57 cases of normal CA were statistically analyzed in this study. Three-step and seven-step FINE automatic quantitative CA showed significantly different from those obtained with manual measurements of CAD ( P=0.005, P<0.001). There were no significant differences in quantitative analysis of CA between three-step or seven-step FINE and manual measurements of CAS ( P=0.458, 0.883), however, there was no correlation between CA using three-step FINE and manual measurement of CAS ( rs=0.056, P=0.679), but there was a positive correlation between CA using seven-step FINE and manual measurement of CAS ( rs=0.599, P<0.001). The linear regression equation was constructed as follows: Y=10.96+ 0.73 X ( R2=0.431, P<0.001). There was no correlation between three-step method and seven-step method for automatic quantitative CA ( rs=0.158, P=0.241). There was significant difference( P<0.001), but strong correlation between manual measurement of CAS and manual measurement of CAD ( rs=0.973, P<0.001), the average difference was ΔCA=(4.5± 3.8)°. The linear regression equation was constructed as follows: Y=-2.94+ 0.96 X ( R2=0.950, P<0.001). Intra-observer and inter-observer measurements had shown no significant difference in consistency and repeatability (all P>0.05). Conclusions:The measurement of fetal CA by seven-step FINE is superior to the three-step FINE when the fetal CA is in normal range. This may be considered a promising aspect that seven-step FINE automatic quantitation of fetal CA can replace the manual measurement of CAS. Future research is needed to deliminate the reliability of automatic quantification of fetal CA by seven-step FINE with the CA in abnormal range.

Objective: To investigate the quality of life of the visual display terminal (VDT) operators in Hangzhou Internet enterprises and to analyze its influencing factors. Methods: Through cluster sampling,, 944 employees were investigated by demographic and general health questions and the MOS 36-Item Short Form Health Survey Questionnaire from October to November in 2016 and carried out statistical analysis. Results: VDT operators’ physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, mental health, physical component summary and mental component summary scores were (86.3±17.0) , (82.5±30.3) , (80.6±16.1) , (56.8±18.6) , (53.7±15.6) , (78.5±17.8) , (81.2±31.9) , (48.8±19.3) , (51.1±8.9) , (43.8±9.1) . Except physical functioning, role-physical and physical component summary scores, the scores of other scales and mental component summary were lower than the norm (P<0.05) . Multivariable logistic regression showed that vegetable intake, sleeping and physical exercise had an impact on the physical component summary score. The influential factors of mental component summary score included marital status, education, neck pain and health concerns. Conclusion We should pay attention to the quality of life of VDT operators in Internet enterprises, especially their mental health.

Exosomes are of great importance in cell communication and information transmission, which have become a hotspot in recent years. Most studies have focused on the transport of microRNA (miRNA) and proteins, that mediated by exosomes, as well as exosomes as a drug delivery carrier of the feasibility. Therefore, exosomes can be an important method of treatment for systemic inflammatory diseases. This article reviews the relevant literature, mainly on the related characteristics of exosomes, its association with clinical disease, and its application in sepsis.

Objective: To investigate the status of immunization of National Immunization Program (NIP) and its adverse reaction rate in children with tuberous sclerosis. Method: Questionnaire survey was adopted to identify the vaccination coverage and its adverse events; 72 cases of children with tuberous sclerosis and 78 normal controls (healthy children completing age-appropriate NIP) admitted to Chinese People′s Liberation Army General Hospital from December 2014 to November 2015 were involved into this study. Result: The age-appropriate NIP coverage rate of tuberous sclerosis was 36%(26/72). The coverage rate of bacillus calmette-guerin (BCG), hepatitis B vaccine 1^st to 3^rd doses (HepB1-3), oral poliovaccine 1^st dose (OPV1), diphtheria, pertussis and tetanus 1^st dose (DPT1), DPT1-3, meningococcal polysaccharide vaccine group A (MPVA), measles amd rubella vaccine/measles vaccine 1^st dose (MRV/MCV1), and Japanese encephalitis vaccine 1^st dose (JEV1) were 100%(72 cases), 75%(51 cases), 97%(66 cases), 91%(62 cases), 82%(56 cases), 66%(45 cases), 69%(42 cases), and 61%(37 cases) respectively. The reasons why the children did not complete the vaccination plan were that parents were concerned about vaccination-induced seizures or seizures had not been controlled. Among 72 children with TSC, the rate of adverse events or suspected adverse events after vaccination was 17% (12 cases), which was higher than the normal control children (2 cases, 3%) (χ²=8.799, P<0.05). The main adverse events were seizure events, which accounted for 92%(11 cases). Conclusion The age-appropriate NIP coverage rate among children with tuberous sclerosis is low. The high incidence of adverse events may be associated with a fact that there are some nervous system abnormalities in cases with tuberous sclerosis. TSC children vaccination is relatively safe, with no serious adverse events.

Objective To explore the value of blood inflammatory load in predicting overall survival of elderly patients with epithelial ovarian cancer (EOC). Methods Elderly patients with EOC were selected, and their clinical data and peripheral blood parameters were collected. We constructed an inflammation-related blood scoring system using univariate and multivariate Cox regression analysis. The Kaplan-Meier method was used for survival analysis. We used Cox proportional hazards analysis to identify the independent prognostic factors. A nomogram model was constructed based on independent prognostic factors, and the receiver operating characteristic curve, C-index, and calibration curve were used to evaluate the model. Results Patients with high blood inflammatory load had worse prognosis (P=0.002). Compared with the low inflammatory load group, patients with high inflammatory load had later clinical stages and larger ascites volume (P<0.05). Cox regression analysis showed that ACCI, CA125, residual lesions, and blood score were independent factors affecting overall survival (P<0.05). Conclusion The blood inflammatory load is the biomarker for the prognosis of elderly patients with EOC. Scoring the inflammatory load in the blood can assist in efficacy monitoring and treatment intervention of ovarian cancer patients.

Objective: To analyze the influencing factors for hospitalization of pneumoconiosis patients, so as to provide reference for improving the timeliness of treatment and quality of life in these patients. Methods: The pneumoconiosis patients in Changshan, Wenling and Changxing ( having mining industry ) of Zhejiang Province were selected by stratified and typical sampling methods. Their demographic features, prevalence of pneumoconiosis and hospitalization status were collected by a questionnaire survey. Logistic regression analysis was conducted to analyze the influencing factors for hospitalization. Results: Among 166 pneumoconiosis patients, 122 ( 73.49% ) chose to be hospitalized. The multivariate logistic regression analysis revealed that the patients who scored higher in ED-5Q ( OR=65.821, 95%CI: 3.831-1130.781 )and who would communicate with other pneumoconiosis patients ( OR=3.744, 95%CI: 1.261-11.115 ) were more likely to be hospitalized; the patients who were under the medical insurance for urban employees were more likely to be hospitalized than those who were under the new rural cooperative medical care system ( OR=0.033, 95%CI: 0.007-0.154 ) and others ( OR=0.038, 95%CI: 0.002-0.960 ) . Conclusion The quality of life, communication with other pneumoconiosis patients and type of medical insurance were the influencing factors for hospitalization of pneumoconiosis patients.

Objective: To investigate the efficacy and safety of rapamycin in children with tuberous sclerosis complex (TSC) associated renal disease. Methods: A prospective self-control study was conducted. The clinical data of 92 children diagnosed with tuberous sclerosis complex associated kidney disease at the People′s Liberation Army General Hospital from January 2011 to January 2019 were collected. The long-term rapamycin treatment for all patients initiated at 1 mg/(m²·d), which was gradually adjusted to reach a blood concentration of 5-10 μg/L. The changes of the maximum diameter of renal lesions in children after rapamycin treatment were observed and analyzed with Wilcoxon test. Results: Ninety-two children, including 52 males and 40 females, who met the criteria were analyzed. Sixty patients had only renal angiomyolipoma(RAML), while 24 patients had only multiple renal cysts(MRC), and 8 patients had both lesions. The age of TSC diagnosis was 16.0 (7.0, 42.0) months, and the age of initial treatment with rapamycin was 63.5 (21.0, 103.0) months. The follow-up lasted for 12.0 (4.0, 23.0) months. Sequencing of TSC1 and TSC2 genes was performed in 54 children with TSC, including 3 patients (6%) with mutations in TSC1 gene and 51 patients (94%) with mutations in TSC2 gene. The maximum RAML diameter before treatment was 7.0 (4.0, 9.0) mm. The best effect reached at 3 months of treatment, with the diameter of 4.0 (0,7.0) mm. The maximum diameters at 6 months, 1 year and 1-2 years were 5.0 (0,9.8) mm, 5.0 (1.5, 8.5) mm, 5.5 (3.0, 9.0) mm, respectively, and were significantly different from the baseline (Z=-2.404,-2.350,-2.750,P=0.016,0.019,0.006, respectively). The maximum diameter after 2-3 years, and ≥3 years were 5.0 (3.9,7.0) mm and 6.0 (1.0, 11.0) mm, without significant difference from the baseline (Z=-0.856,-0.102,P=0.393,0.919, respectively).The maximum diameters of MRC after 3 months, 6 months, 1 year,1-2 years, 2-3 years, and ≥3 years were 11.0 (5.0, 14.0) mm,3.0 (0.0,11.0) mm,5.0 (0,21.0) mm,0 (0,14.0) mm,0 (0,10.0) mm, and 0 (0,18.3) mm, respectively, but were not significantly different rom the baseline (7.0 (5.0, 15.7) mm)(Z=-0.944,-1.214,-1.035,-1.896,-1.603,-1.214,P=0.345,0.225,0.301,0.058,0.109,0.225, respectively).Twenty-nine patients (32%) had oral ulcers during the entire treatment period, and no serious adverse reactions were observed. Conclusions Rapamycin could decrease the diameter of TSC-related RAML, but could not inhibit the growth of cysts. It is well tolerated in the treatment of renal diseases associated with tuberous sclerosis complex.