ObjectiveTo explore the role of risk management in reducing the nursing risk of junior nurses in operation room. Method The risk management was implemented among junior nurses in operation room including establishing training groups for risk management,establishing instructor system,classifying nursing risk events and formulating operation room nursing risk monitoring. Result After risk management,the rate of risk events in the junior nurses was lowered as compared to pre-enforcement of the risk management(P<0.001).Conclusions The risk management can improve the risk awareness of junior nurses in operation room and reduce the incidence of nursing risk events.

Objective: To explore the early diagnostic value of dynamic changes for high-sensitive troponin I (hs-cTnI) in patients with acute coronary syndrome (ACS).
Methods: A total of 186 ACS patients treated in our hospital from 2014-02 to 2015-04 were studied. The patients were divided into 2 groups:AMI group, n=169 and UA group, n=17, in addition, there was a Control group, n=13 healthy subjects. Blood levels of hs-cTnI were measured at admission and 2h, 4h after admission. Dynamic changes of hs-cTnI was calculated by slop coefifcient of hs-cTnI (Δhs-cTnI) at 3 time points and relative changes of hs-cTnI values. ROC curve was made by SPSS 16.0 statistical software and the best diagnostic cutoff point was determined by Youden index.
Results: In clinical practice, hs-cTnI=1 ng/ml was critical condition, hs-cTnI=0.15 ng/ml was recommended for AMI diagnosis. When hs-cTnI<1 ng/ml at admission, the AUC of AMI vs UA and AMI vs Control for 0 h hs-cTnI were 0.6746 and 0.8844;for relative changes of hs-cTnI were 0.9806 and 0.9631;forΔhs-cTnI were 0.9521 and 0.9778 respectively. Thus, the best diagnostic cutoff value of AMI for relative changes of hs-cTnI was 0.6705, sensitivity 70.59%, speciifcity 91.49%;forΔhs-cTnI was 0.0075, sensitivity 68.75%, speciifcity 97.78%. When hs-cTnI<0.15 ng/ml at admission, the AUC of AMI vs UA and AMI vs Control for 0 h hs-cTnI were 0.5677 and 0.7000;for relative changes of hs-cTnI were 0.9228 and 0.9975;forΔhs-cTnI were 0.9044 and 0.8906 respectively. Thus, the best diagnostic cutoff value of AMI for relative changes for hs-cTnI was 2.923, sensitivity 81.25%, speciifcity 94.12%;forΔhs-cTnI was 0.01125, sensitivity 76.47%, speciifcity 93.75%.
Conclusion: AMI could not be effectively diagnosed by hs-cTnI alone at admission, using combined relative changes of hs-cTnI andΔhs-cTnI was superior to 0 h hs-cTnI for AMI diagnosis.

Objective To discuss the remedy and clinical effect of traumatic splentic rupture.Methods Clinical data of 32 cases of traumatic splentic rupture were retrospective analyzed.Results No dead cases,6 cases were cured by conservative treatment,18 cases were explored by laparoscope,and 14 cases remained spleen,4 cases were converted to traditionary splenectomy.Traditionary splenectomy was done on 8 cases directly.Conclusions Ⅰ,Ⅱ grade of traumatic splentic rupture may choose conservation treatment or remain spleen by laparoscope operation.Splenectomy should be done on Ⅲ,Ⅳ grade of traumatic splentic rupture in time.

Objective To investigate the operative indications for polypoid lesions of gallbladder(PLG) and avoid cholecystectomy for PLG without operation signs.Methods Retrospective analysis of 828 cases of PLG confirmed by pathologic examination was made.Results (1)Cancer should be suspected when a patient is older than 50 years or has a polypoid lesion larger than 1.0 cm.(2)The cholecystectomies for PLG accounted for 2.7%-7.1%of all cholecystectomies in the corresponding period,and cholesterol polyps accounted for 86.11%of all PLG,and carcinoma of gallbladder accounted for 1.92%of all PLG.Conclusion At present most of PLG accepting cholecystectomy are cholesterol polyps,so the high-risk factors of the neoplastic polyps and the operative indications for PLG should be considered deliberately.

Objective To investigate the efficacy of conventional laparoscopy and mini-laparoscopic surgery in the treatment of endometriosis(EM). Methods From September 2015 to November 2016, 35 cases of endometriosis were treated with mini-laparoscopic surgery(mini group,15 cases)or conventional laparoscopic surgery(conventional group,20 cases)in Beijing Huafu Women&Children's Hospital.The peri-operative parameters,incidence of complications, and symptom relief rate were observed in both groups. Results The operation time was(68.2 ±2.1)min in the mini group,which was significantly shorter than that in the conventional group[(78.4 ±2.3)min,t=13.468,P=0.000].The intraoperative blood loss was significantly less in the mini group (12.1 ±6.7)ml than that in the conventional group[(21.4 ±7.8)ml, t=-3.703, P =0.000].The recovery time of gastrointestinal function was significantly lower in the mini group(21.5 ±7.6)h than that in the conventional group[(28.6 ± 7.4)h,t=-2.777, P=0.009].The hospital stay was significantly shorter in the mini group(2.7 ±1.1)d than that in the conventional group[(3.7 ±1.1)d,t=-2.662,P=0.012].The incidence of postoperative complications was 6.7%(1/15)in the mini group,which was significantly lower than that in the conventional group[40.0%(8/20), Fisher exact test, P =0.048]. Postoperative pathology:the mini group had 6 cases of deep infiltration type EM, 9 cases of pelvic EM, and 7 cases of ovarian chocolate cysts; the traditional group had 13 cases of deep infiltration type EM, 7 cases of pelvic EM, and 10 cases of ovarian chocolate cysts.The follow-up time was 3-9 months,including 15 cases in the mini group for(6.2 ±2.8)months and 20 cases in the conventional group for(6.8 ±2.6)months.There was no significant difference between the two groups in symptom relief rate[93.3%(14/15)vs.85.0%(17/20)]and the recurrence rate[20.0%(3/15)vs.20.0%(4/20), Fisher exact test, P=0.619 and 1.000]. Conclusion Mini-laparoscopic surgery for EM has advantages of small incision, shorter hospital stay, and less postoperative complications,being worthy of clinical promotion.

This study is to evaluate the therapeutic effect of fibroblast growth factor 21 (FGF21) on NAFLD in MSG-IR mice and to provide mechanism insights into its therapeutic effect. The MSG-IR mice with insulin resistance were treated with high dose (0.1 micromol.kg-1d-1) and low dose (0.025 micromol.kg-1d-1) of FGF21 once a day for 5 weeks. Body weight was measured weekly. At the end of the experiment, serum lipids, insulin and aminotransferases were measured. Hepatic steatosis was observed. The expression of key genes regulating energy metabolism were detected by real-time PCR. The results showed that after 5 weeks treatment, both doses of FGF21 reduced body weight (P<0.01), corrected dyslipidemia (P<0.01), reversed steatosis and restored the liver morphology in the MSG model mice and significantly ameliorated insulin resistance. Additionally, real-time PCR showed that FGF21 significantly reduced transcription levels of fat synthetic genes, decreased fat synthesis and promoted lipolysis and energy metabolism by up-regulating key genes of lipolysis, thereby liver fat accumulation was reduced and liver function was restored to normal levels. In conclusion, FGF21 significantly reduces body weight of the MSG-IR mice, ameliorates insulin resistance, reverses hepatic steatosis. These findings provide a theoretical support for clinical application of FGF21 as a novel therapeutics for treatment of NAFLD.

ObjectiveTo evaluate the influence of electrotome on permanent and temporary cardiac pacemaker in laparoscopic cholecystectomy ( LC),and the application of cardiac pacemaker to the cases of cholecystolithiasis combined with bradyarrhythmia.MethodsClinical data of 215 patients with permanent or temporary cardiac pacemaker who underwent were studied for the preoperative and postoperative variation of pacemaker function,and for the influence of electricity coagulation during the operation on cardiac pacemaker function.ResultsLC was successfully completed in all 215 patients.The function of cardiac pacemaker was not obviously interfered during the operation,and the parameters of cardiac pacemaker did not remarkably change after the operation.ConclusionCardiac pacemaker is slightly interfered when electrotome and electrocoagulation were used in LC; LC is feasible and safe for patients with bradyarrhythmia by placement of cardiac pacemaker.

Objective:To explore the method of constructing an early mortality risk prediction model for patients with sepsis-induced cardiorenal syndrome by machine learning algorithm, so as to provide a basis for early clinical identification of high-risk patients and accurate treatment.Methods:Patients with sepsis-induced cardiorenal syndrome from January 1, 2015 to May 31, 2019 in Tongji Hospital, Tongji University were enrolled. Basic characteristics, laboratory indexes, hospitality treatment and other relevant baseline data were collected. Thirty-day mortality was defined as the primary end-point event after the enrolled patients were diagnosed. Python software was applied to establish different machine learning models, and the area under the receiver -operating characteristic curve ( AUC) was used to evaluate the predictive value of models. Disease-related risk factors were selected according to the most optimal model. Importantly, visualized decision tree and semi-naive Bayesian (sNB) models were established to further explore the interrelationship between these risk factors. Results:A total of 340 patients were included, of whom 114 patients (33.5%) died within 30 days after diagnosis. The AUC of support vector machine (SVM), random forest (RF), gradient boosting decision tree (GBDT), extreme gradient boosting (XGBoost), and light gradient boosting machine (LGBM) prediction models were 0.652, 0.868, 0.870, 0.754, and 0.852, respectively. The AUC of GBDT model had the most efficiency to predict end-point events, and the prediction AUC value was better. According to the feature ranking of GBDT model, the relevant influencing factors were selected, including total sequential organ failure assessment (SOFA) score, neural SOFA score, vasoactive drug application, cardiac troponin I (cTNI), age, myoglobin, circulation system SOFA score, chronic kidney disease, heart rate and baseline serum creatinine. Visualized decision tree model had 4 layers, 15 nodes and 8 terminal nodes as evidenced by total SOFA score, myoglobin, baseline serum creatinine and age. The total SOFA score, change rate of myoglobin, serum creatinine and age were included into the visualized decision model. The AUC value of the model for predicting end-point event was 0.690. sNB model revealed complex correlation between the risk factors, in which neural SOFA score was related to total SOFA score, vasoactive drug application was related to total SOFA score, and cTNI was related to baseline serum creatinine. Conclusions:A risk prediction model for patients with sepsis-induced cardiorenal syndrome is established and the model showes that high SOFA score remains the primary risk factor for patients with sepsis-induced cardiorenal syndrome based machine learning. Visualized decision tree and sNB models help clinicians to further identify the dependence and logic relationship among these risk factors clearly and provide a novel method to predict mortality risk for patients with sepsis-induced cardiorenal syndrome.

Objective To investigate the effects ofpravastatin on the expression ofmicroRNA-155 (miR-155) and the functions of lipopolysaccharide (LPS)-treated extravillous trophoblast cells.Methods In vitro cultured HTR-8/SVneo cells were divided into the following groups:control group,enhanced plasmid with green fluoscent protein (pEGFP)-miR-155 group (transfected with green fluorescent protein-tagged miR-155),LPS group (treated with 100 ng/mL of LPS),miR-155 inhibitor+LPS group,pravastatin+LPS group (treated with 100 ng/mL of LPS following pretreatment with 12.50,25.00,50.00 and 100.00 μ g/ml of pravastatin),and pravastatin+pEGFP-miR-155 group (transfected with pEGFP-miR-155 following pretreatment with 50 μ g/ml of pravastatin).Levels of miR-155 in HTR-8/SVneo cells treated with different strategies were measured by real-time polymerase chain reaction.Expression of phosphorylated JunB (p-JunB) and p-FosB proteins was analyzed by Western blotting.Migration,invasion and apoptosis of HTR-8/SVneo cells were also analyzed.All data were analyzed with t test.Results (1) Compared with the control group,HTR-8/SVneo cells in the pEGFP-miR-155 group were characterized by shorter migration distance [(274.70± 18.82) vs (181.00±8.62) μ m],less transmembrane cells [(123.00±4.36) vs (63.00±6.08)] and enhanced apoptosis [(5.40± 0.68)％ vs (9.27±0.68)％] (all P＜0.05).(2) Compared with the LPS group,the miR-155 inhibitor+LPS group showed longer migration distance of HTR-8/SVneo cells [(166.30±5.07) vs (242.00±18.07) μm,P＜0.05],more transmembrane cells [(71.67±6.12) vs (109.00±7.81),P＜0.05] and decreased cell apoptosis [(14.40±1.69)％ vs (6.23± 0.44)％,P＜0.05].(3) Expression of miR-155 at mRNA level in the LPS group was increased as compared with that of the control group (1.65 0.07 vs 0.79±0.12,P＜0.05).Compared with the LPS group,pretreatment with 12.50,25.00,50.00 and 100.00 μ g/ml of pravastatin decreased the expression of miR-155 at mRNA level [(1.14±0.10),(1.02±0.10),(0.74±0.15) and (1.140.02)],especially at the concentration of 50 μμ g/ml (all P＜0.05).(4) Expression ofp-JunB and p-FosB proteins in the control,LPS and pravastatin (50 μ g/ml)+LPS groups were (0.33 ±0.06) vs (0.37±0.07),(1.22±0.20) vs (0.80±-0.13),and (0.31 ±0.02) vs (0.21 ±0.05),respectively,showing higher expression level in both p-JunB and p-FosB proteins in the LPS group compared with that of the other two groups (all P＜0.05).(5) Compared with the LPS group,the pravastatin (50 μμ g/ml)+LPS group showed increased migration distance [(166.30±5.07) vs (246.80± 13.42) μ m,P＜0.05],increased numbers of transmembrane cells [(71.67 ± 6.12) vs (95.33 ± 2.73),P＜0.05] and decreased cell apoptosis [(14.40± 1.69) vs (6.05 ± 0.35)％,P＜0.05].(6) Compared with the pEGFP-miR-155 group,the pravastatin (50.00.00 μμ g/mL)+pEGFP-miR-155 group showed longer migration distance [(197.50± 13.86) vs (275.80± 13.63) μ m,P＜0.05],more transmembrane cells [(52.67±5.49) vs (125.00±6.66),P＜0.05] and lower rate of cell apoptosis [(8.90± 1.00) vs (5.05±0.35)％,P＜0.05].Conclusions Pretreatment of extravillous trophoblast cells with pravastatin can protect them from apoptosis and loss of migratory and invasive abilities through inhibiting the activation of AP-1 and down-regulating the expression of miR-155,which may be a mechanism that inhibits the development of preeclampsia.

Nasopharyngeal carcinoma is one of the most common malignant head and neck tumors, and radiotherapy is the main treatment. However, radio-resistance is a key cause of local recurrence of nasopharyngeal carcinoma. Therefore, overcoming the radio-resistance of nasopharyngeal carcinoma and enhancing the radiosensitivity have become urgent problems in the treatment of nasopharyngeal carcinoma, which also play a key role in improving the overall survival rate of patients. In this article, recent studies on DNA, non-coding RNA (ncRNA), protein and cell behaviors related to radio-resistance of nasopharyngeal carcinoma were reviewed, aiming to provide valuable ideas for clinical treatment of nasopharyngeal carcinoma.