Surgical shunt is still an effective method in managing portal hypertension related gastrointestinal bleeding.To minimize the invasive trauma and adverse effect on transplantation remains to be the unsolved problem.Herein we present the use of a newly designed surgical shunt to cure massive refractory gastrointestinal tract hemorrhage in a patient,who was critically ill because of the extensive thrombus in portal venous system.The procedure is named gastrojugular shunt.For the sake of its simple operation and effective outcome,the procedure was performed on four other patients.All the patients were well treated and recovered uneventfully with good follow up results.

Objective To study the therapeutic effects of human umbilical cord mesenchymal stem cells (hUCMSCs) on acute liver failure ( ALF) induced by D-galactosamine (D-gal) and lipopolysaccharide (LPS) in rats. Methods The ALF model was obtained through intraperitoneal injection of D-gal(300 mg/kg)and LPS (20μg/kg)in Wister rats. The hUCMSCs were transplanted after intoxication. All rats were divided into four groups, and each group received either hUCMSCs or 0.9% NaCl solution through intraperitoneal or tail-intravenous injection. To evaluate the liver function of each group, the levels of alanine aminotransferase (ALT), total bilirubin (TBil) and serum albumin (Alb) were measured on the day of hUCMSCs transplantation and the following 1, 2, 3, 5 and 7 days. All rats were then sacrificed to examine the liver histology at day 7. Analyses were done by using Fisher's exact test, unpaired t test and Mann-Whitney U test. Results There were no significant differences of survival rates among four groups (Fisher's exact test, both P = 1. 00). The levels of ALT, TBil and Alb in group receiving hUCMSCs intraperitoneally were (804. 9 ± 88. 0) U/L,(17. 4±2. 7) μmol/L and (20. 9±0. 8) g/L, respectively after 2 days of injection, whereas in the corresponding control group, those were (1294. 3± 171. 4) U/L, (32. 3±5. 5) μmol/L and (16. 1±0. 9) g/L, respectively, which indicated that hUCMSCs transplantation significantly improved the liver function (t = 2. 640, P =0.020;t=2.529, P = 0. 025;t= - 3. 833, P = 0. 002). Both of hUCMSCs-transplanted groups showed no significant differences. Liver histological data showed that transplantation of hUSMSCs through either intraperitoneal or tail-intravenous injection alleviated liver damage (U=4. 500, P = 0. 005;U=4. 500, P = 0. 008) and the mitotic index also increased in hUCMSCs-transplanted groups (U=4. 000, P = 0. 005; U=5. 500, P = 0. 013). Conclusions The levels of ALT, TBil and Alb can rapidly normalize in ALF rats after injected with hUCMSCs either intraperitoneally or tail-intravenously. hUCMSCs application raises the mitotic index, enhances hepatocellular regeneration and improves histological status.

Objective:To understand the current state of financial toxicity and suicide risk in head and neck cancer patients, to investigate the correlation between the level of financial toxicity and suicide risk in head and neck cancer patients, and to provide a basis for reducing the level of financial toxicity and the risk of suicide in head and neck cancer patients.Methods:A cross-sectional survey was conducted, from March 1 to July 31, 2022, 150 head and neck cancer patients were selected from Oncology Department of East Hospital Affiliated to Tongji Universityby by convenient sampling method. The survey was carried out by means of the general questionnaire, Comprehensive Score for Financial Toxicity based on the Patient-Reported Outcome Measures (COST-PROM), Cancer Suicide Risk Scale (CSRS), and then analysis the datum.Results:The score of COST-PROM of 150 head and neck cancer patients was (18.00 ± 6.12) points, and the score of CSRS of head and neck cancer patients was (36.31 ± 8.51) points. The total score of economic toxicity was significantly negatively correlated with the total score of suicide risk and its dimensions ( r values were -0.446 to 0.235, all P<0.05). The total score of suicide risk was negatively correlated with the total score of economic toxicity and the scores of each dimension ( r values were -0.446 to -0.251, all P<0.05). Conclusions:Patients with head and neck cancer were at higher risk of suicide, and financial toxicity was a significant contributing factor to suicide risk, with higher levels of financial toxicity associated with a higher risk of suicide. Reducing the level of financial toxicity in patients with head and neck cancer has important implications for reducing their risk of suicide.

Objective:To retrieve, screen, evaluate and synthesize evidence related to the management of pregnant women during pregnancy after cervical cerclage to provide a basis for clinical practice.Methods:According to the "6S" evidence resource pyramid model, the system searched of all evidence on the management of pregnant women after cervical cerclage in databases suchas UpTo Date, BMJ Best Clinical Practice, International Guidelines Network, American Guidelines Network, World Health Organization website, Yimaitong, Metz Medical website, Clinical Guidelines website, American College of Obstetricians and Gynaecologists, Royal College of Obstetricians and Gynaecologists of the United Kingdom, Canadian College of Obstetricians and Gynaecologists, French College of Obstetricians and Gynaecologists, European Association of Perinatal Medicine, Cochrane Library, the Joanna Briggs Institute (JBI), the Centre for Evidence-Based Health Care Database, PubMed, Embase, Scopus, Web of Science, CNKI, Wanfang Database, VIP Database, and China Biomedical Literature Database, including best dicision practices, guidelines, expert consensus, evidence summary, systematic reviews, Meta-analysis. The search time limit was the establishment of the database to March 1, 2023, and the evidence was extracted and summarized according to the theme after the two researchers independently evaluate the quality of the literature.Results:A total of 8 studies were selected, including 2 expert consensuses, 2 systematic reviews and 4 guidelines. Through literature reading, evidence extraction and classification, 23 pieces of best evidence were summarized from seven aspects: systematic management, activity management, medication management, health behavior management, pregnancy supervision, supervision of the timing of cerclage removal and supervision of psychological state.Conclusions:The best evidence quality and autuority of pregnancy management for pregnamt women after cervical cerclage surgery summarized in the study are high. It was recommended to strengthen the management of pregnant women during pregnancy after cervical cerclage, dynamically and continuously assess the pregnancy status of pregnant women, and prudently selected evidence to improve the prenatal examination process, ensure the safety of mothers and babies, and reduce the occurrence of complications. Overall, effective management of pregnant women during pregnancy after cervical cerclage required a combination of many factors to ensure the health and safety of the mother and baby.

Objective To investigate the status of self-efficacy in cardiac disease patients when discharged, and to explore the influencing factors .Methods A total of 403 patients were selected from Cardiology and Cardiothoracic Surgery Department in a three-A hospital during March to August in 2013 .The chronic disease self-efficacy scale and the basic information questionnaire of cardiac disease patients ( self-designed) were administered to these patients when discharged .Differences of self-efficacy between medical and surgical patients were compared , and the influencing factors were analyzed .Results The average score of self-efficacy for these patients was (6.63 ±1.90), which belonged to the medium level.There was a significant difference between medical and surgical patients in self-efficacy (7.27 ±1.83 vs 6.01 ±1.75;t=-7.080,P<0.01).Univariate analysis showed that the influencing factors of self-efficacy in patients including age, education background , heart function level , and the number of hospital admissions and length of hospital stay . Conclusions The self-efficacy in cardiac disease patients is in the medium level , and the self-efficacy of surgical patient is lower than that in the medical patients .

Objective:To describe the family resilience experience of colorectal cancer patients′ spouses in the process of care, and to provide reference for making effective clinical nursing interventions.Methods:Objective sampling method was used to select the spouses of colorectal cancer patients who were hospitalized in Shanghai East Hospital from March to April 2023. A phenomenological research was used. Semi-structured, in-depth interviews were conducted with 10 spouses of colorectal cancer patients undergoing colostomy. Data was transcribed and analyzed using Colaizzi′s method.Results:Three themes were extracted: family crisis and coping pressure including increased burden of care, accompanying emotional internal friction, heavy economic pressure; internal adjustment and adaptation within the family including positive family beliefs, timely adjustment of family roles, clear and effective communication and interaction; integration and utilization of external resources including active access to information, medical professional support, social external support.Conclusions:With the help of the perspective of family advantage, medical staff should pay attention to the evaluation of care needs and family resilience of colorectal cancer patients′ spouses, to fully mobilize advantage resources and give effective intervention measures to improve the family and social adaptation level of patients and their spouses.

Objective To understand the situation of nursing teamwork against a background of high-quality nursing service and to explore the influencing factors of nursing teamwork so as to find out practical solutions to improve the level of nursing teamwork.Methods A total of 380 nurses of a classⅢ grade A general hospital in Shanghai Municipality were investigated with the nursing teamwork survey (NTS) by cluster sampling in June 2016. The data were analyzed with SPSS 20.0.Results The median of the total score of NTS among nurses was 4.31 (the full marks are 5). The scores of four dimensions from the highest to the lowest were: team leader (4.75), shared mental models (4.50), trust and support (4.38), team-oriented (4.00). The influencing factors of nursing teamwork included departments, weekly working hours, overtime hours and most often shift nearly three months, whether planed to leave current operating post and departments human resource allocation with significant differences (P<0.05).Conclusions There is still room for improvement in nursing teamwork. Promot teamwork among nurses through reasonably allocating nursing human resources, scientifically scheduling, strengthening humanistic concern and reducing negative effects.

Objective:To conduct a scoping review on the application of family resilience intervention in adults with chronic disease.Methods:Related studies published from database establishment to October 30, 2023 were systematically searched on PubMed, Web of Science, Cochrane Library, PsycINFO, CINAHL, Scopus, China National Knowledge Infrastructure, Wanfang Data, VIP, and China Biomedical Database. The included literature was summarized and analyzed.Results:A total of 9 articles were included. The intervention elements for family resilience included increasing awareness of diseases and family characteristics, solving and responding to family problems, engaging in family interaction and communication, integrating internal and external resources, and providing psychological and technical support. The outcome indicators were the level of family resilience and effectiveness.Conclusions:The intervention of family resilience in adults with chronic disease has certain effectiveness and clinical significance, but research is still in the exploratory stage. Further high-quality research is needed to verify the long-term intervention effect and feasibility, and to construct a diversified family resilience intervention program suitable for China.

Objective To study the role of MDCT with 3D fusion images in the preoperative evaluation of pancreaticoduodenectomy.Methods 37 patients who underwent pancreaticoduodenectomy from March 2016 to May 2018 in the Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University were included in this retrospective study.All patients underwent a dual-phase enhanced MDCT before operation.The volume data of enhanced MDCT were transmitted to a dedicated CT post-processing workstation.The 3D images,including the tumor,pancreas,portal vein system,arterial system,pancreatic and biliary tract,were reformatted respectively before the fusion imaging.Two reviewers analyzed the tumor location and its spatial relations with the pancreaticobiliary system,peripancreatic vessels and vascular variations by means of zooming,rotating,splitting and transparent displaying on fusion images.Then,the assessed items were compared to the surgical and pathological findings.Results The 3D fusion images of 37 patients in this study depicted the tumor,pancreas,peripancreatic vessels and pancreatic and biliary tract clearly.Compared with the intraoperative and pathological findings,the accuracy of both tumor detection and localization with the 3D fusion images was 100％.To compare the intraoperative findings,visualization and variation detection of the celiac,splenic,common hepatic,gastroduodenal,hepatic,and superior mesenteric arteries,and the superior mesenteric and portal veins were all 100％.Visualizations of the anterior superior pancreaticoduodenal artery (ASPDA),posterior superior pancreaticoduodenal artery (PSPDA),inferior pancreaticoduodenal artery (IPA) and dorsal pancreatic artery (DPA) were 85.7％,82.8％,72.2％ and 75.8％,respectively.Conclusion The MDCT 3D fusion imaging technology allowed one stop preoperative assessment of pancreaticoduodenectomy,especially in clearly outlining the tumor location and its spatial relations with the surrounding surgical anatomies before surgery.

Objective To introduce and translate the English version of Team Development Measure (TDM) into Chinese one and evaluate the reliability and validity of the Chinese version for general practitioner teams to provide a basis for studying the development of the general practitioner teams.Methods According to the Guidelines for the Process of Cross-Cultural Adaptation of Self-report Measures, we completed the translation and culture debugging. Using the convenient sampling method, a total of 26 community health centers were selected which included 85 general practitioner teams for investigation and analyzing the reliability and validity of TDM. The data were statistically analyzed by SPSS 20.0 and AMOS 22.0.Results The correlation (r) between each item and total score of item analysis was 0.251-0.695 (all P<0.001). AllCR values of these items were greater than 3.0 except item 17 and item 23. By use the CFA method,KMO=0.912, and got 4 common factors finally, which could explain 54.3% of overall variance; and had a good fitness CFA confirmed. The Cronbach's α coefficients of the total scale and each dimensions were 0.925,and 0.680-0.916 respectively. The retest reliability was 0.787 (P<0.001).Conclusions The Chinese version of TDM has good reliability and validity and can be used as a tool for measuring the general practitioner team development.