After defining chronergy for medical instruments maintenance,this paper generalizes the importance of maintenance chronergy,and puts forward some specific methods for its improvement.

Objective To summarize the experience in the treatment of cardiac and thoracic aortic injury.Methods 30 patients with cardiac and thoracic aortic injury from 1996 to 2007 are retrospectively studied,including the diagnosis,preoperative preparation,main points of the operation and cardiopulmonary resuscitation.Results 24 patients were completely cured,having no residual in the follow-up periods.4 patients with multiple wound died of complication.2 patients with thoracic aortic injury died in the operation.Conclusion Prompt diagnosis after injury,fast preoperative preparation,precise operative approach and technique,effective cardiopulmonary resuscitation and refraining from omitting associated injury are the key points to the salvage of cardiac and thoracic aortic injury.

Objective To investigate the expression of membrane type 1 matrix metalloproteinase(MT1-MMP) in the esophageal carcinoma tissues and in normal periearcinomatous tissues and its clinical significance. Methods Immunohistochemistry was used to study the expression of MT1-MMP in esophageal carcinoma tissues and normal tissues in distance for 5-7 em from tumor. Results Among 54esophageal carcinoma specimens, the positive expression rate of MT1-MMP was 87.0%, while all of themwere expressed a small quantity in normal esophageal epithelial tissues, the expression in the esophageal carcinoma tissues was significantly higher than those in normal esophageal epithelial tissues (P ＜ 0.01 ).The degree of MT1-MMP expressions was associated with the depth of tumor invasion (P ＜ 0.01 ), the invasion of the lymph nodes(P ＜ 0.01 ) and the relapse and/or metastasis of the tumors for three years after surgery(P ＜0.01 ), and was also related to differentiation of tumor cells (P ＜ 0.01 ). Conclusions The expression of MT1-MMP in the esophageal carcinoma tissues is well associated with the depth of tumor invasion, the invasion of the lymph nodes, the differentiation of tumor cells and relapse and/or metastasis of the tumors for three years after surgery. MT1-MMP plays an important rote in the invasion and metastasis in the patients with esophageal carcinoma.

Objective:To explore the application effect of narrative nursing in long-term primary family caregivers of maintenance hemodialysis patients.Methods:Using the convenient sampling method, a total of 120 main family caregivers of maintenance hemodialysis patients who received hemodialysis treatment in Hemodialysis Room of a tertiary general hospital were selected as the research objects from May to August 2020. The patients were randomly divided into the observation group ( n=60) and the control group ( n=60) by random number table method. The observation group was given narrative nursing intervention, while the control group was given routine psychological nursing. Zarit Caregiver Burden Interview (ZBI) , Self-rating Anxiety Scale (SAS) and Beck Depression Scale (BDI-Ⅱ) were used to investigate the situation of caregivers in the two groups. Results:Before the intervention, there was no statistically significant difference in the total scores of ZBI, SAS and BDI-Ⅱ between the two groups ( P>0.05) . After the intervention, the total scores of ZBI, SAS and BDI-Ⅱ in the observation group were respectively 23.50 (15.00, 33.00) , 33.00 (27.00, 41.00) and 11.00 (8.00, 14.75) , which were lower than the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Narrative nursing can effectively reduce the long-term care burden of the main family caregivers of maintenance hemodialysis patients and reduce levels of anxiety and depression, which is worthy of clinical application.

Objective:To test the reliability and validity of the Chinese version of the Demoralization Scale-Ⅱ (DS-Ⅱ) in maintenance hemodialysis (MHD) patients.Methods:This was a cross-sectional study. From October 2021 to February 2022, 989 patients who received MHD in 16 hospitals in Xiangyang City, Hubei Province, were selected by convenience sampling as the study subject. The patients were investigated with the General Information Questionnaire, DS-Ⅱ, Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) . The correlation coefficient and critical ratio were used for project analysis. The reliability of the total scale and sub-scale were tested by Cronbach 's α coefficient, split half reliability coefficient, retest reliability coefficient. The exploratory factor analysis was used to determine item pool dimension and scale structure, and the confirmatory factor analysis was used to test the structural validity of the scale. We tested the correlation among the scores of SAS, SDS and Chinese version of DS-Ⅱ. A total of 989 questionnaires were distributed, and 920 valid questionnaires were recovered, with a valid recovery rate of 93.02% (920/989) . Results:The correlation coefficient among each item score and the total score of the scale was 0.679 to 0.777 ( P<0.05) . The critical ratio of each item in high score group and low score group was 21.637 to 30.719 ( P<0.05) . The total content validity coefficient of the scale was 0.984, and the content validity coefficient of each item was 0.875 to 1.000. Two common factors were extracted after exploratory factor analysis, and the cumulative variance contribution rate was 59.844%. The confirmatory factor analysis showed that the model fitted well, and the correlation coefficients among items and dimensions were 0.687 to 0.803. The total score of DS-Ⅱ and each factor score were positively correlated with scores of SAS and SDS ( P<0.05) . Cronbach 's α coefficient of the total scale was 0.944, and the split half reliability Guttman 's coefficient was 0.884, and the retest reliability coefficient was 0.909. Conclusions:The Chinese version of DS-Ⅱ has good reliability and validity in MHD patients.