Objective To investigate the incidence and related factors of postoperative hemorrhage, so as to provide data support for preventing its occurrence and developing reasonable risk assessment tools. Methods The retrospective analysis of clinical data of 50 patients with postoperative hemorrhage after surgical operation in a 3A hospital in Shanghai from January to December 2016 was conducted. A 1:2 matching case-control study was conducted to explore the risk factors of postoperative bleeding in surgical patients by univariate and multivariate regression analysis.Results The total number of surgical operations (excluding obstetrics and gynecology, five senses) was 18942. Postoperative hemorrhage occurred in 50 cases, including 6 deaths. The incidence of postoperative hemorrhage was 0.26％ and the mortality rate was 12％. The incidence of postoperative bleeding in the top four departments were gastrointestinal surgery (13 cases), hepatobiliary and pancreatic surgery (11 cases), cardiac surgery (10 cases), neurosurgery (9 cases). The statistical analysis of binary Logistic in the case group and the control group showed that postoperative albumin<35g/L, postoperative AST abnormality, postoperative ALT abnormality, postoperative hypertension were independent risk factors of postoperative bleeding.Conclusions The incidence of postoperative bleeding in this hospital is relativelylow, but the mortality is relatively high. Medical staff should pay more attention to the patients undergoing gastrointestinal, liver, pancreas, heart and brain surgery. It is also necessary to pay more attention to the blood pressure, albumin and liver function of the patients after operation,and establish the evaluation of prevention of hemorrhage, which has a certain early warning effect on the prevention of postoperative hemorrhage.

Objective:To explore the influencing factors of bowel preparation quality in hospitalized elderly patients, and to find the appropriate waiting time from the end of bowel preparation to the beginning of colonoscopy.Methods:Baseline and clinical data of elderly patients over 60 years old who underwent colonoscopy in the Tenth People′s Hospital, Tongji University from February 2021 to August 2021 were collected. Multivariate analysis was used to screen the factors that might affect the quality of bowel preparation in hospitalized elderly patients. Patients were grouped according to waiting time before colonoscopy. After eliminating confounding factors using propensity matching analysis, the difference of bowel preparation quality among groups was compared.Results:251 patients were included in the study. Multivariate analysis revealed that, hypertension ( OR=3.530, 95% CI 1.295-9.618), chronic constipation ( OR=3.302,95% CI 1.132-9.632), dietary compliance ( OR=0.161, 95% CI 0.070-0.371), medication and drinking water compliance ( OR=0.167, 95% CI 0.070-0.397), exercise compliance after medication ( OR=2.245, 95% CI 1.040-4.845), The frequency of defecation after medication ( OR=0.446, 95% CI 0.308-0.647) and waiting time ( OR=0.537, 95% CI 0.387-0.745) were important factors affecting the quality of bowel preparation in hospitalized elderly patients ( P<0.05). There were differences in bowel preparation quality between groups of waiting times. The overall quality of bowel preparation in 120-180 min group was significantly better than that in 241-300 min group, 301-360 min group and>360 min group ( P<0.05). The overall quality of bowel preparation in 181-240 min group was better than that in >360 min group ( P<0.05). There were no significant differences among other groups( P>0.05). The scores of cecum and ascending colon were the best in 120-180 min group, and the cleanliness of descending colon, sigmoid colon and rectum was significantly higher in 241-300 min group, 301-360 min group and > 360 min group. The scores of descending colon, sigmoid colon and rectum showed that the intestinal preparation quality of 181-240 min group was better than that of 301-360 min group and > 360 min group. Conclusions:The best examination time for elderly patients is about 180 minutes after bowelpreparation. Medical workers should flexibly guide the medication time to ensure that patients are in the best clean state of intestinal tract during examination.

Objective:To explore the status quo of the readiness of evidence-based nursing practice for the maintenance and removal of children's central venous catheter (CVC) in 6 domestic medical institutions Pediatric Intensive Care Unit (PICU), analyze the obstacles faced by the application of CVC maintenance and removal evidence in PICU, so as to provide basis for formulating reform strategies.Methods:This study was a cross-sectional survey. In December 2019, 169 nurses from PICU of 6 medical institutions in Shanghai, Guangzhou, Shenzhen, Hangzhou, Xiamen and Hefei were selected by convenience sampling for investigation. The General Information Questionnaire and Clinic Readiness to Evidence-based Nursing Assessment (CREBNA) were used to evaluate the readiness of clinical nurses to evidence, organizational environment and promoting factors in the process of evidence-based practice. A total of 169 questionnaires were issued, and 169 valid questionnaires were recovered, with a valid recovery rate of 100%.Results:A total of 169 nurses were investigated in 6 evidence application sites. The total score of the multi center CREBNA was (136.96±15.33), which was 88.36% of the full score. The scores of the three dimensions were as follows: organizational environment (40.31±4.45), evidence dimension (53.43±6.14), and promoting factors (43.22±5.81). Four of the last five items in the score ranking were from the promoting factor, and the low score items in four places were all from the promoting factor.Conclusions:The best practice project of children's CVC maintenance in PICU is feasible. However, there are still some deficiencies in the preparation of various evidence application sites, especially in the promoting factors, which should be constantly improved to further promote and maintain the implementation of change.

ObjectiveTo explore the mechanism of herbal cake-separated moxibustion using the classical formula Xiaoyaosan in alleviating neuroimmune inflammatory responses in chronic fatigue syndrome （CFS） rats， based on the regulation of the toll-like receptor 4 （TLR4）/myeloid differentiation factor 88 （MyD88）/nuclear transcription factor-κB （NF-κB） signaling pathway. MethodsFifty SPF-grade SD rats aged 6-8 weeks were randomly divided into five groups： Normal group， model group， sham herbal cake moxibustion group， Chinese medicine intragastric administration group， and herbal cake-separated moxibustion group， with 10 rats in each group. Except for the normal group， all other groups underwent a 21-day modeling process， followed by behavioral testing. The herbal cake-separated moxibustion and sham herbal cake moxibustion groups received interventions at the Shenque （CV8）， Guanyuan （CV4）， Zusanli （ST36）， and Qimen （LR14） acupoints. The Chinese medicine intragastric administration group was treated with a Xiaoyaosan suspension via gavage. Behavioral tests were conducted after 10 days of continuous intervention. Serum levels of interleukin （IL）-1β， IL-6， and tumor necrosis factor-α （TNF-α）， as well as hippocampal levels of IL-1β， IL-6， TNF-α， and NF-κB， were detected by enzyme-linked immunosorbent assay （ELISA）. Morphological changes in the hippocampus were observed using hematoxylin-eosin （HE） staining. Real-time quantitative polymerase chain reaction （Real-time PCR） was used to detect mRNA expression levels of TLR4， MyD88， and NF-κB in the hippocampus. Western blot analysis was performed to detect the relative expression levels of TLR4， MyD88， NF-κB， and p65 proteins in the hippocampus. ResultsCompared with the normal group， the model group showed a significant decrease in upright times during the open field test （P<0.01）， as well as significant reductions in total movement distance， resting time， and center region duration （P<0.01）. In the tail suspension test， immobility time increased （P<0.01）， and struggle times decreased （P<0.01）. Serum and hippocampal levels of IL-1β， IL-6， and TNF-α， as well as hippocampal NF-κB levels and TLR4， MyD88， and NF-κB mRNA expression， were significantly elevated （P<0.01）. After treatment， compared with the model group， the total movement distance and upright times in the open field test were significantly increased in all treatment groups （P<0.01）， while resting time and center region duration were notably prolonged （P<0.05， P<0.01）. Immobility time in the tail suspension test was significantly shortened （P<0.01）， and struggle times significantly increased （P<0.05）. Serum and hippocampal levels of IL-1β， IL-6， TNF-α， hippocampal NF-κB levels， and TLR4 and NF-κB mRNA expression were significantly reduced （P<0.05， P<0.01）. Compared with the sham herbal cake moxibustion group， the herbal cake-separated moxibustion group showed a significant extension in center region duration during the open field test （P<0.05） and a significant increase in upright times （P<0.01）. In the tail suspension test， immobility time was reduced （P<0.01）， and struggle times increased （P<0.01）. Serum TNF-α levels in the Chinese medicine intragastric administration group were significantly reduced （P<0.01）， while serum IL-6 levels， as well as hippocampal levels of IL-1β， TNF-α， NF-κB， and TLR4， MyD88， and NF-κB mRNA expression， were significantly decreased in both the Chinese medicine intragastric administration group and the herbal cake-separated moxibustion group （P<0.05， P<0.01）. Compared with the Chinese medicine intragastric administration group， the herbal cake-separated moxibustion group exhibited significantly increased upright times in the open field test （P<0.01）. In the tail suspension test， immobility time was reduced （P<0.01）， and struggle times increased （P<0.01）. Serum IL-1β， hippocampal TNF-α levels， and TLR4， MyD88， and NF-κB mRNA expression were significantly decreased （P<0.05， P<0.01）. ConclusionHerbal cake-separated moxibustion effectively improves fatigue and memory function in CFS rats， regulates neuroimmune inflammatory responses， and its mechanism may be related to the modulation of the TLR4/MyD88/NF-κB signaling pathway.

Objective: To understand the working experience of responsible nurses after the day surgery in the ward under the concept of accelerated rehabilitation surgery, in order to provide reference for the development of targeted interventions. Methods: In this study, 10 primary nurses in 4 departments of day surgery in Shanghai Tenth People′s Hospital were interviewed by using the method of objective sampling in April-May, 2018. The semi-structured interview was conducted using the phenomenological research method in the qualitative study, and the Colaizzi phenomenological data was used. The analysis method analyzes the interview data. Results: Through the repeated refinement, analysis and extraction of the interview data, the following two themes reflecting the work experience of the daytime surgical department responsible nurses: own growth and harvest, difficulties and challenges. Conclusion Based on the concept of accelerated rehabilitation surgery, daytime surgery is carried out to encourage responsible nurses to continuously improve their knowledge level and interpersonal communication skills. The nurses' professional identity is continuously improved. At the same time, due to the increase in nursing workload, the increase in nurse training needs and the incomplete workflow make nursing management Facing new problems and challenges.