To evaluate the efficacy of heparin combined with low molecular heparin against early thrombosis in chronic patients after native arteriovenous fistula ( AVF) . Methods: A total of 299 patients were enrolled in the study from January 2012 to December 2014 and randomly divided into two groups. The control group received 5000IU low molecular heparin after the operation for 7 days and the trial group received 3 000u heparin additionally through free arterial end and venous terminal during the operation. The thrombosis formation rate and adverse drug reactions ( ADR ) of one week and 4 weeks after the operation were observed in the two groups. Results:One week after the operation, the thrombosis formation rate in the control group and the trial group was 3. 4% and 0, respectively, and four week after the operation, that was 4. 8% and 0. 67%, respectively. The incidence of ADR showed no statistical-ly difference between the two groups (P>0. 05), and no severe ADR appeared in both groups. Conclusion:Heparin combined with low molecular heparin may be more effective and safer in the prevention of primary thrombosis in the patients after AVF.

Objective To explore the factors affecting compliance of patients with maintenance hemodialysis and to provide reference for the improvement of patients' compliance.Methods Ten patients with maintenance hemodialysis were individually interviewed in this study.The data were analyzed based on phenomenological method.Results Three factors were found,including feasibility of doctor's advice,characteristics of patients such as awareness of disease related knowledge,recognition todisease progression and usual behavioral pattern,as well as social factors such as economic status,life pressure,family support,professional supervision and guidance.Conclusion In order to enhance patients' compliance,it is suggested to improve thefeasibility of doctors' advice and health education,as well as pay close attention to the influence of patients' recognition,psychological status and social factors on the compliance.

OBJECTIVE:To discuss the general regularity and characteristics of the drug-induced edema so as to provide reference for clinical safe medication.METHODS:173 drug-induced edema cases publicly reported in domestic journal from 2001 to 2006 were analyzed statistically.RESULTS:The drug-induced edema was more often seen in males than in females,but not linked to age.It was characterized by early onset,with 76(43.9%)showing edema within 1h.It was chiefly induced vial oral and intravenous routes.The drug-induced edema was caused by 17 drug categories(or 115 kinds),with antibacterials showing the highest percentage(31.2%,54 cases).Laryngeal edema,which occurred in 57 cases,was the chief type among all the edema cases.CONCLUSION:Drug-induced edema is a common adverse drug reaction,which should be given great attention in the clinic,much as in the case of acute laryngeal edema.Clinicians should give close monitoring on patients after medication to guard against possible events.

To improve the effectiveness of nurse-patient communication and build a harmonious nurse-patient relationship, a list of melodrama of the whole nursing process from admission to discharge was designed and demonstrated. This means of training by scenarios demonstration significantly enhanced nurses' awareness and skills of nurse-patient communication with high recognition.

Objective To evaluate complete mesocolic excision in laparoscopy-assisted right hemicolon carcinoma radical resection. Methods Laparoscopy-assisted right hemicolon carcinoma radical resection with complete right-side mesocolic excision was performed in 36 cases between June 2010 and July 2011 at Zhongshan Hospital,Xiamen University. Results The operations were completed successfully without conversion to open surgery.The mean operative time was (134 ±22) min.The blood loss was (95 ±53 ) ml.The median number of total lymph nodes removed was 15.7.The average time for passage of flatus was (3.1 ± 1.2) d.The postoperative complications were observed in 6 of 36 cases (17％) including lymphatic fistulas in 4 patients,pulmonary infection in 1 patient and postoperative bleeding in 1 case.Conclusions Laparoscopy-assisted complete right-side mesocohc excision can be successfully performed for right hemicolon carcinoma,and the lymphoid tissue could be eliminated maximally.The long-term results need further evaluation.

Objective: To investigate the clinicopathological and ultrastructural characteristics of Langerhans cell histiocytosis (LCH) in children. Methods: A total of 345 cases of LCH from the Department of Pathology, Beijing Children Hospital from January 2012 to March 2016 were investigated by hematoxylin-eosin stain, EnVision immunohistochemistry and transmission electron microscopy. Results: The rate of primary clinical diagnosis of LCH in children was 46.0%(210/457). Among 345 patients of LCH, 213 were male and 132 were female, the male to female ratio was 1.6∶1.0, and the median age was 21 months (range from 2 days after birth to 13.3 years). There were total 597 lesions, including bony lesions (258, 43.2%), skin lesions (206, 34.5%) , followed by lymph node (16, 2.7%), lung (28, 4.7%), liver (25, 4.2%) and head-neck (50, 8.4%). Single organ system LCH (SS-LCH) was seen in 295 cases (85.5%) and 50 cases (14.5%) presented with multiple organ system involvement LCH (MS-LCH). There was no significant difference in age and gender between SS-LCH and MS-LCH groups. Regarding sites, more lesions were seen in bone and skin in SS-LCH group, in contrast lymph node, lung, liver and head-neck involvements were often seen in MS-LCH group. Immunohistochemically, the expression of CD1a and Langerin was seen in 99.7% (341/342) and 98.8% (338/342) of the cases respectively. The diagnostic rates by light and transmission electron microscopy were 98.8% (341/345) and 97.4% (112/115) respectively (P>0.05). Conclusions LCH of children occurs predominantly in SS-LCH pattern, frequently involving bone, skin, lymph node, lung and liver and other sites with unique histopathological, immunophenotypical and ultrastructural features. Accurate diagnosis relies on the morphology, immunophenotype and ultrastructural features. Further refinement of specimen processing may improve the accuracy of pathological diagnosis.

Objective:To investigate the regression of regional lymph nodes after administering neoadjuvant short-course chemoradiother-apy combined with immunotherapy in patients with locally advanced rectal cancer(LARC).Methods:This retrospective study analyzed the clinical data of 40 patients with LARC admitted to Zhongshan Hospital Affiliated to Xiamen University(32 cases)and the Union Hospital,Tongji Medical College,Huazhong University of Science and Technology(8 cases)between January 2021 and December 2022.The control and experimental groups consisted of 20 patients who underwent direct laparoscopic surgery and neoadjuvant short-course chemoradio-therapy combined with immunotherapy prior to the laparoscopic surgery,respectively.The detection of the postoperative lymph node was compared between the two groups.In addition,the pathologic complete response(pCR)rate of the primary tumor and regional lymph nodes in the experimental group was assessed.Results:The number of patients with N downstaging(18 vs.7,P<0.001)significantly in-creased,whereas the positive lymph node metastasis rate(1.4%vs.19.1%,P<0.001)and number of patients with positive lymph nodes(4 vs.16,P<0.001)significantly decreased in the experimental group compared to those in the control group.Although the number of detected lymph nodes in the experimental group was slightly lower compared to that in the control group(18.3±8.7 vs.20.4±6.5,P=0.392),it was not statistically different.Furthermore,the pCR rate of the regional lymph nodes was significantly higher than that of the primary tumor in the experimental group(80%vs.30%,P=0.001).Conclusions:Neoadjuvant short-course chemoradiotherapy combined with immunotherapy caused significant pathological remission of positive lymph nodes in patients with LARC.This study hypothesizes that a"spatial effect"con-tributes to the pathological remission of regional lymph nodes in rectal tumors.

Objective: To identify the impeding and promoting factors of role definition in nursing handoff, in order to increase the quality of nursing handoff. Methods: Two nursing managers, 22 head nurses and four nurses were recruited by purpose sampling. Data were collected by using focus group study, and analyzed using content analysis. Results: According to the framework of role transition theory, the factors could be classified as individual factors (37 items, 23.72%), organizational factors (105 items, 67.31%), effectiveness of role definition (11 items, 7.05%), and problems of role definition (3 items, 1.92%). Conclusions Role definition in nursing handoff helping the coming nurse check the performance of the last shift and transfer the nursing responsibility, contributes to the improvement of nursing quality, but there are still many factors affecting the role definition in nursing handoff.

Objective: To test the reliability and validity of the Chinese version of the Handoff Clinical Examination Exercise (Handoff CEX). Methods: The Chinese version of the Handoff CEX was composed of two parts, one to assess the nurse providing the handoff and another to assess the nurse receiving the handoff. A total of 80 handoffs was evaluated to test the reliability and validity of the Chinese version of the Handoff CEX. Results: A total of 320 evaluations of handoff was obtained. The Cronbach α coefficient was 0.85 for the handoff provider, and that was 0.80 for the handoff recipient. Weighted kappa scores for provider evaluations ranged from 0.31-0.52, and that for recipient evaluations ranged from 0.35-0.55. The correlation coefficients between each factor ranged from 0.23 to 0.62, and that between each factor and the total scale ranged from 0.33 to 0.64 (P<0.05). Experienced nurses (>5 years) received significantly higher mean scores than inexperienced nurses(≤5 years) in all domains except organizational efficiency and professionalism(P<0.05). Conclusion The Chinese version of the Handoff CEX is a reliable and valid tool to assess the nursing handoff, which is useful for educators, supervisors and clinical nurses to provide training, ongoing assessment and feedback to improve the quality of handoff.

Objective: To evaluate the disinfection efficacy of peracetic acid disinfectant (type Ⅲ ) on gastrointestinal endoscopy. Methods: Endoscopes were disinfected respectively by 2% glutaraldehyde (GA group) and peracetic acid disinfectant (type Ⅲ ) (PAA group) according to the process by the 2016 version of "Regulation for cleaning and disinfection technique of flexible endoscope" , and then samples were collected through biopsy channel at the specified steps. The bacterial count and pathogenic bacteria of these samples were detected. Hepatitis B virus surface antigen (HBsAg), hepatitis C virus (HCV) antibody and Treponemia pallidum antibody (TP-Ab) were detected by chemiluminesent microparticle immunoassay (CMIA) in the PAA group. The PAA group were continuously sampled for 5 days. Results: A total of 56 gastroscopes and 16 colonoscopes were disinfected in the GA group, and 46 gastroscopes and 15 colonoscopes were disinfected in the PAA group. Compared with pre-disinfection, the bacterial count was both significantly reduced in the two groups after disinfection (P<0.05). The qualified rate of gastroscopes disinfection and total qualified rate of the PAA group were higher than those of the GA group [the qualified rate of gastroscopes: 97.83% (45/46) VS 92.86% (52/56), P>0.05; total qualified rate: 98.36% (60/61) VS 94.44% (68/72), P>0.05]. The qualified rate of colonoscopes in the two groups were both 100.00% (15/15, 16/16). After disinfecting by peracetic acid disinfectant (Type Ⅲ), HBsAg, anti-HCV and TP-Ab were negative. There were no significant differences on colonies number at different steps in a 5-day continuous sampling (P>0.05). Conclusion Peracetic acid disinfectant (type Ⅲ) can provide a satisfied disinfectant effect, and be applied in clinic to meet the requests of high-level disinfection for gastrointestinal endoscopy.