Objective To discuss the nursing care for patients with advanced hepatocellular carcinoma (HCC) who are receiving transcatheter arterial chemoembolization (TACE) combined with sorafenib. Methods A total of 23 consecutive patients with advanced HCC who met the inclusion criteria were enrolled in this study. TACE was carried out in all patients. Three-five days after TACE the patients started to orally take sorafenib. During the treatment course, the patients were kept under close observation for adverse reactions and complications. After leaving the hospital the patients were followed up by the extended care team members, and health education as well as appropriate nursing intervention was carried out. Results All patients with advanced HCC took sorafenib orally after TACE. The major adverse events and complications were gastrointestinal adverse reactions (n = 22) and transient liver dysfunction (n = 23). After leaving the hospital all the patients received regular follow- up examination and extended nursing care. Conclusion Usually, the incidence of adverse reactions is higher in patients with advanced HCC after TACE combined with sorafenib treatment. Careful in-hospital observation and extended out-hospital nursing can reduce the incidence of adverse reactions and thus improve the patient’s quality of life.

Objective To investigate the accuracy of the plasma DNA concentration in evaluating the prognosis in patients with sepsis.Methods One hundred and sixty patients with sepsis were enrolled as the sepsis group (group SE).Another 109 patients without sepsis hospitalized during the same period served as the control group (group C).The venous blood sample was taken on admission for determination of plasma DNA concentration by polymerase chain reaction,C reactive protein (CRP) concentration by ELISA.APACHE Ⅱ score and SOFA score were evaluated at 24 h after admission.The 160 patients with sepsis were divided into two groups according to the result of prognosis:survival group ( n =103) and death group ( n =57).Results Compared with group C,the plasma DNA concentration,CRP concentration,APACHE Ⅱ score and SOFA score were significantly increased in group SE (P＜0.05).Compared with survival group,the plasma DNA concentration,APACHEⅡ score and SOFA score were significantly increased in death group ( P ＜ 0.05).The areas under receiver operating characteristic (ROC) curves of the plasma DNA concentration was significantly larger than those of APACHE Ⅱ score and SOFA score (0.81(95％ CI,0.74-0.88) versus 0.68(95％ CI,0.60-0.77),or 0.72(95％ CI,0.63-0.82)).Conclusion The plasma DNA concentration can accurately evaluate the prognosis in patients with sepsis.As compared with the plasma CRP concentration,APACHE Ⅱ score and SOFA score,the plasma DNA concentration is more accurate to evaluate the prognosis in patients with sepsis.

Objective To study the feasibility and necessity of radial artery angiolgraphy in advance on transradial coronary intervention.Methods A total of 682 patients undergoing transradial coronary intervention were divided into two groups by random digits table method.Previous radial artery angiography (pre-RAA) group of 341 cases underwent radial artery angiography;post radial artery angiography (post-RAA) group of 341 cases in the guide wire,catheter in resistance immediately for radial artery angiography.The radial artery imaging characteristics were observed and the radial artery related complications were recorded in two groups.Results The ratio of radial artery spasm in post-RAA group was higher than that in pre-RAA group [11.4％(39/341) vs.6.2％(21/341),P=0.015].The ratio of operation failed in post-RAA group was higher than that in pre-RAA group [3.2％ (11/341) vs.0.6％ (2/341),P =0.014].The radial artery perforation rate and postoperative 1-6 months of radial artery occlusion rate increased significantly in post-RAA group,and there was significant difference between two groups (P ＜ 0.05).Conclusion Transradial coronary intervention in advance for radial artery angiography therapy can effectively observe the radial artery morphology,reduce the radial artery related complications.

The relevant policies of national essential medicine system were reviewed, major concerns and actions in the implementation of essential medicine system in Shanghai were introduced, and the suggestions to improve the implementation of essential medicine system of Shanghai were made. These provided the information for policy making and provided a useful experience for facilitating the establishment of essential medicine system and the improvement of its implementation in Shanghai as well as China.

Objective:To observe the therapeutic effect of recombinant human brain natriuretic peptide (rhBNP)on patients with cardiorenal syndrome.Methods:The data of 75 patients,who were diagnosed as cardiorenal syndrome and hospitalized in our hospital,were retrospectively analyzed.They were randomly divided into routine treatment group (n=40,received routine treatment)and rhBNP group (n=35,received rhBNP based on routine treatment) according to number table method.The rhBNP was pumped with 0.0075μg·kg-1 ·min-1 using micropump intrave-nously,once/day,about 10h/time and 7d was regarded as a course of treatment.Changes of 24h urine volume,N terminal pro brain natriuretic peptide (NT-proBNP),glomerular filtration rate (GFR)and echocardiograph were recorded in all patients before and 7d after treatment.Results:Compared with routine treatment group after treat-ment,there were significant increase in total effective rate (62.5% vs.94.3%),24h urine volume [(785.2 ± 143.4)ml vs.(965.34±171.8)ml],GFR [(34.1±2.6)ml/min vs.(45.2±5.6)ml/min]and left ventricular e-jection fraction [(35.6±5.5)% vs.(45.9±6.8)%],and significant reduction in NT-proBNP level [(3451.1± 1314.2)pg/ml vs.(1516.43 ± 431.52)pg/ml]in rhBNP group,P<0.01 all.Conclusion:Recombinant human brain natriuretic peptide is safe,effective and can improve renal function in treating patients with cardiorenal syn-drome.

Objective To systematically evaluate the psychological intervention effect of music therapy on the patients during the digestive endoscopic process.Methods The databases of EMbase,PubMed,Cochrane Library,CNKI,VIP,Wanfang and CSCD were retrieved by computer,the retrieval time was from their establishment to March 2016.The randomized controlled trials (RCTs) on the music therapy application in the digestive endoscopic process were included.The data were independently extracted by 2 researchers for conducting the literature quality assessment.After extracting and checking the data,the meta analysis was performed by using the RevMan 5.3 software.Results Twenty-six RCTs conforming to the standard were included,involving 4593 patients.The meta analysis results showed that the music therapy could alleviate the anxiety status(SMD=-0.82,95％ CI:-1.14--0.49,P＜0.01),relieve the pain perception(WMD=-1.27,95％CI:-1.87--0.66,P＜0.01),remit the vital signs fluctuations of blood pressure,heart rate and respiratory rate(P＜0.01),meanwhile shorten the duration of examination procedure (WMD=-4.64,95％CI:-6.75--2.52,P＜0.01).Conclusion The current evidences indicate that the music application during the digestive endoscopic process can obviously decrease the anxiety status and pain perception.

Objective To investigate feasibility and clinical application value of improved percutaneous transhepatic biliary internal-external drainage (PTBIED).Methods Consecutive patients from April 2007 to April 2010 with malignant obstructive jaundice were diagnosed by medical imaging or pathological confirmation whenever possible.The patients with proximal malignant biliary obstruction and intact inferior common bile ducts ＞ 3 cm in length,and a bilirubin of 70 μmol/L or higher,were included in the experimental group.The control group included patients with low malignant biliary obstruction,and those who met the criteria for the experimental group but refused to receive the altered method of PTBIED.The patients underwent traditional PTBIED in control group.The patients in the experimental group received the procedure as following:according to percutaneous transhepatic cholangiography,a biliary external drainage catheter was modified by adding side-holes.Then under fluoroscopic guidance,the loop tip of the modified biliary drainage catheter was positioned in the inferior common hepatic duct/common bile duct,while the additional side-holes were located in the expanded hepatic duct.Technical success rate,complications,hepatic function and white cell count (WBC) were recorded pre- and post-procedure.All patients were followed-up until death.A t-test was used to compare continuous variable data changes,the Chi-square test was used to compare categorical variable data in two groups,and survival time was assessed using the Kaplan-Meier method.Results Forty-six patients were included in the study,with 21 in the experimental group and 25 in the control group.The procedures were successfully performed in all patients in the two groups.There was no procedure-related death in the two groups.Symptoms were improved similarly after procedures in the two groups.The mean quantity of drained bile per day [experimental group (521 +136) ml/d,control group (606 + 159 ) ml/d,t =1.930,P ＞ 0.05],decrease of the serum total bilirubin after the procedures [ experimental group (87 ± 51 ) μmol/L,control group( 105 ± 66 ) μmol/L ( t =1.061,P ＞ 0.05 ) ] and the median survival time ( experimental group 7.7 months,control group 6.9 months,x2 =0.610,P ＞0.05 ) of the patients showed no statistically significant difference between two groups.The mean WBC amount of patients was higher after the traditional procedure [ ( 10.9 ±5.2) × 109/L] than before the procedure [ (7.8 ±2.9) × 109/L] in the control group ( t =3.606,P ＜ 0.05 ),but the converse change occurred in the experimental group [ pre-procedure (8.2 ± 3.4) × 109/L ],post-procedure [ (7.4 ± 2.6) × 109/L] ( t =2.649,P ＜ 0.05 ).No reflux of duodenal juice was observed in all patients of the experimental group,and 1 patient had infection of biliary tract.The reflux was observed in 11 patients of the control group after conventional PTBIED.Of them,8 patients had infection of biliary tract.Incidence rate of infection of biliary tract in the control group was higher than that in the experimental group( x2 =5.381,P ＜ 0.05 ).Conclusions Improved PTBIED is convenient and feasible,and compared with traditional PTBIED,it can reduce the complications of infection of biliary tract.

Objective:To construct a Bayesian network risk prediction model for delirium during recovery from general anesthesia. To explore the network relationship between awakening delirium of general anesthesia and its related factors, and to reflect the influence intensity of each factor on awakening delirium of general anesthesia through network reasoning.Methods:This is a cross-sectional study. From February to May 2022, the Chinese version of the four rapid delirium diagnosis protocols for general anesthesia patients admitted to the department of Anesthesia, the First Hospital of Shanxi Medical University were adopted as research subjects through convenience sampling method to carry out the delirium screening program during awakening, and general information and blood sample laboratory test results of the subjects were collected. The single factor analysis was used to screen the correlative factors of awakening delirium and a Bayesian network model based on the maximum minimum climb method (MMHC) was constructed.Results:A total of 480 patients were included in the study, and the delirium rate during the recovery period of general anesthesia was 12.9%(62/480). The Bayesian network of awakening delirium consisted of 11 nodes and 18 directed edges. The Bayesian network showed that age, sodium, cerebral infarction and hypoproteinemia were the direct factors related to awakening delirium, while ASA grade, hematocele and hemoglobin were the indirect factors related to awakening delirium. The area under its ROC curve was 0.80(0.78-0.83).Conclusions:Bayesian networks can well reveal the complex network connections between awakening delirium and its related factors, and then prevent and control awakening delirium accordingly.

Gardeniae Fructus (GF) and Semen Sojae Praeparatum (SSP) are both medicine food homologies and widely used in Chinese clinical prescriptions together. The research investigated the pharmacokinetics of four iridoids in normal rats and isolfavones-fed rats, which were administered with isolfavones from SSP for 7, 14, 21 and 28 consecutive days. A validated LC-MS/MS method was developed for determining shanzhiside, genipin-1-gentiobioside, geniposide and their metabolite genipin in rat plasma. Plasma samples were pretreated by solid-phase extraction using paeoniflorin as the internal standard. The chromatographic separation was performed on a Waters Atlantis T3 (4.6 mm × 150 mm, 3μm) column using a gradient mobile phase consisting of acetonitril and water (containing 0.06％acetic acid). The mass detection was under the multiple reaction monitoring (MRM) mode via polarity switching between negative and positive ionization modes. The calibration curves exhibited good linearity (r>0.997) for all components. The lower limit of quantitation was in the range of 1-10 ng/mL. The intra-day and inter-day precisions (RSD) at three different levels were both less than 12.2％ and the accuracies (RE) ranged from -10.1％ to 16.4％. The extraction recovery of them ranged from 53.8％ to 99.7％. Pharmacokinetic results indicated the bioavailability of three iridoid glycosides and the metabolite, genipin in normal rats was higher than that in rats exposed to isoflavones. With the longer time of administration of iso-flavones, plasma concentrations of iridoids decreased, while genipin sulfate, the phase II metabolite of genposide and genipin-1-gentiobioside, appeared the rising exposure. The pharmacokinetic profiles of main iridoids from GF were altered by isoflavones.