Objective To evaluate the impact of pathologic parameters and lymphatic mierometastasis on 5-year disease-frtee survival in patients with stages Ⅰ and Ⅱ colorectal cancer.Methods Surgical operation was performed in 126 patients with stage Ⅰ and Ⅱ colorectal cancer.Sixteen (range,10-28)lymph nodes were harvested in each specimen and immunohistochemical staning was performed. Theimpact of pathologic parameters and lymphatic micrometastases in survival was estimated by KaplanMeier.Results The mean follow up time was 64.11 (range,64-106) months. Multivariate analysisrevealed that lymphatic vessel invasion and depth of tumor invasion were correlated with positive CEA in lymph node,and unrelated with clinical pathologic factors.There was no significant difference between pathologic parameters and five year disease-free survival rates. The five-year diseasse-free survival rates was 75.4 percent in CEA negative patients,68.2 percent in patients with isolated tumor cells,and 46.2 percent in patients positive for micrometastasis.There was no significant difference in 5 year disease-free survival between CEA negative patients and patients with isolated tumor cells (P=0.245).However,the5-year disease-free survival was lower in patients positive for micrometastases compared to CEA negativepatients (P=0.003).Conclusions The presence of micrometastases in patients with stages Ⅰ and Ⅱ colorectal cancer may result in poor prognosis and high recurrence,and adjuvant chemotherapy will bejustified and effective.

Objective To observe recombinant plasmids were constructed with the macrophage colony-stimulating factor ( GM-SCF) , interleukin -21 (IL-21) and retinoic acid early transcription factor-1 (Rae-1), and observe the inhibitory effects in subcutaneous liver cancer model in mice with the recombinant plasmids.Methods The recombinant plasmids of GM-SCF, IL-21 and Rae-1 were constructed with RT-PCR method, mouse model was constructed, the model mice were randomly divided into six groups including control, IRES/GFP, IRES/IL21, IRES/GM-SCF, IRES/GM-SCF-IL21 and IRES/combination with 10 mice included in each group, each groups (15 mice) were treated with the corresponding gene therapy.The survival rate were observed after 60 days.The blood levels of interferon -γ(IFN-γ) and interleukin -2 (IL-2) were detected in each group.Results The pGM-CSF-GFP-IRES-Rae-1-IL-21 has been successfully constructed.All mice had demised 14 and 16 days after treatment in the control and IRES/GFP groups, respectively.There were 2, 1, 11 mice remaining after 60 days of treatment in the IRES/GM-SCF, IRES/IL21 and IRES/GM-SCF-IL21 groups respectively.The survival rate of mice at 60 days of treatment was 73.33%, 13.33%, and 6.67% for groups IRES/GM-SCF-IL21, IRES/GM-SCF and IRES/IL21, respectively.The survival rate of the mice was significantly higher in IRES/GM-SCF-IL21 than the other groups.The levels of IL-2 and INF-γof mice 1-6 days after treatment gradually increased in the IRES/combination groups, including IRES/GM-SCF-IL21, IRES/GM-SCF and IRES/IL21.They were highest in the IRES/combination group and lowest (P<0.01) in the IRES/GM-SCF and IRES/IL21 groups, with the IRES/GM-SCF-IL21 group showing intermediate levels.By 6-10 days after treatment, IL-2 and INF-γlevels had stably increased in the IRES/combination groups, but had gradually decreased in the IRES/GM-SCF-IL21, IRES/GM-SCF and IRES/IL21 groups.At the end of treatment, IL-2 and INF-γlevels were significantly (P<0.01) higher in the IRES/GM-SCF-IL21 than were found in either the IRES/GM-SCF group or IRES/IL21 group, which were also significantly (P<0.01) higher than either the IRES/GFP or control groups.The levels of IL-2 and INF-γwere highest in the IRES/combination group ( P<0.01) and not significantly different among the IRES/GM-SCF, IRES/IL21, IRES/GFP, and control groups.Conclusion The inhibitory effects in subcutaneous liver cancer model in mice were obvious significantly, and its mechanism maybe be related to the activation of the body's immune.

Objective To evaluate the prognostic impact of a wide spectrum of pathologic parameters in a consecutive series of homogenously treated and well-characterized patients with stage Ⅰ and Ⅱ colorectal cancer, and to investigate the prognostic value of lymph node occult disease (micrometastasis) in disease-free survival rate detected by immunohistochemistry with epithelial membrane antigen and carcinoembryonic antigen. Methods The study included 126 patients operated on by a single surgeon for stage Ⅰ and Ⅱ colorectal tumors. The postoperative follow-up was performed for 64 to 106 months. At least 10 lymph nodes were harvested and examined in all the specimens. The prognostic value of 10 pathologic parameters, including lymph node occult disease (micrometastasis) detected by immunohistochemistry was investigated. Results Multivariate analysis identified lymphatic vessel invasion (absent or present;P=0.009) in lymph node positive and negative by immunohistochemistry. The five-year disease-free survival rates were 78.7%, 65.5% and 43.8% for the lymph node negative, isolated tumor cells and micrometastasis groups, respectively. There was significant difference between the lymph node negative and micrometastasis groups (P=0.005). However, the difference between the lymph node negative and isolated tumor cells groups was not statistically significant (P=0.144). Conclusions We propose that for patients found micrometastasis in lymph node with high-risk stage Ⅰ and Ⅱ colorectal cancer, adjuvant therapies are justified and effective.

Objective To explore the influencing factors of ICU nurses' perception disturbance in pain management.Methods One hundred and fifty-seven ICU nurses recruited from 5 first glass grade A hospitals in Guangdong were involved in the survey by the Perception Disturbance in Pain Management Scale.Results The average total score of the ICU nurses by the scale was(3.00±0.38). The dimensions were ranked in an ascending order to be‘nurses themselves’(3.16±0.45),‘government and hospital policies’ (3.11±0.74)and‘patients and their families’(2.59±0.49).The major factors influencing the disturbance were work experience and attention from the hospital administration.Conclusions ICU nurses have disturbance of perception in pain management.The training on pain management to them should be enhanced and the attention to the disturbance from hospital administration should be improved for the purpose of improving their knowledge on pain management and reducing the disturbance of perceptioin.

Objective To explore the synergetic effect of HBX protein and M2 macrophages in inflammatory microenvironment on invasion and metastasis of hepatocellular carcinoma cells.Methods Hep3B cells were infected with recombinant lentivirus carrying HBx gene,following co-culture with THP-1 original M2 macrophages.The cells were divided into six groups:two infected groups (Hep3B +and Hep3B + + M2),four non-infected groups (Hep3B-,Hep3B-+ LV5,Hep3B-+ M2,Hep3B-+LV5 + M2).Western blot (WB) was used to assess the expression changes of E-cadherin and N-cadherin,markers of epithelial-mesenchymal transition (EMT).The cellular location of EMT markers was observed by immunofluorescence confocal microscopy.Transwell assay was used to evaluate the invasion ability of Hep3B cells.Results HBX protein overexpressed in Hep3B cells by lentivirus infection.After 72 h co-culture with M2 macrophages,WB results showed that E-cadherin descreased significantly in Hep3B+ (0.42 ±0.11) when compared with Hep3B-(1.00 ±0.18) (t =4.762,P ＜0.05),while N-cadherin was significantly higher in Hep3B + (2.85 ± 0.44) than in Hep3B-(1.00 ± 0.17) (t =4.762,P ＜ 0.05).M2macrophages decreased E-cadherin expression in Hep3 B + + M2 (0.1 ± 0.13) compared with Hep3 B + (t =3.255,P ＜0.05),while N-cadherin expression increased in Hep3B+ + M2 (4.18 ± 0.52) (t=10.009,P ＜ 0.05).Non-Infected groups didn't change the markers of E-cadherin and N-cadherin.It was suggested that invasion ability of Hep3B increased by HBx overexpression.Conclusions HBX protein and M2 macrophages synergetically mediated the invasion and metastasis of hepatocellular carcinoma cells by EMT.

Objective To establish a set of ICU care quality indicators real-time monitoring information system. Methods Based on the evaluation index system of ICU nursing safety quality, the real-time monitoring information system of ICU nursing quality indicators is established which quality evaluation index of structure quality、process quality and outcome quality is planted. To investigate the satisfaction of ICU medical staff in the use of informatization system and compare the quality of care quality before and after the use of the system. Results The satisfaction of ICU nurses in reducing working load, recording time, operation convenience, parameter acquisition and quality index monitoring were all greater than 90％. System before and after six months of intensive medicine nursing quality indicators, the overall quality had improved.The rate of ventilator recumbent incorrect position, the nonconformity rate of oral cavity clean, incidence of catheter-associated urinary tract infections, incidence of central line-associated bloodstream infection, incidence of ventilator associated pneumonia before information system were 2.03％ (118/5806), 0.53％ (10/1883), 0.51‰(4/7818), 0, 1.55‰(9/5614), which were lower than 4.90％(275/5614), 3.92％(69/1734), 3.12‰(24/7685), 1.06‰(8/7547), 4.81‰(27/5614) after six months (χ2=8.16-70.56, P<0.01).The accidental release rate of artificial airway was not statistically significant (P> 0.05). Conclusion The ICU nursing quality indicator real- time monitoring information system makes nursing management digital, improves the satisfaction of medical staff, and significantly improves the quality of care.

ICU nursing is a vitalpartof the development of specialized nursing in China, and the standardized training of the corecompetence of ICU nurses is the primary goal of the development of ICU nursing. This paper took the First Affiliated Hospital of Sun Yat-sen University in China and the Royal Free Hospital in London, the United Kingdom as example, and compared the hierarchical management and core competencies training status of ICU nurses in China and England to find out the similarities and differences, and then to put forward valuable suggestions for hierarchical management and the core competence training of ICU nurses in China.

Objective: To investigate the application of clohexidine wipes in patients after liver transplantation and the effect of infection prevention. Methods: A total of 279 patients who received orthotopic liver transplantation in the first affiliated hospital of sun yat-sen university from January 2017 to December 2018 and were transferred to the intensive care department of our hospital after the surgery were selected as subjects. Among them, 145 patients who received liver transplantation between January and December 2017 were selected as the control group. From January to December, 2018, 134 patients after liver transplantation were enrolled as the intervention group, and were treated with clohexidine 2% gluconate wet wipes, and the hospital infection rate, infection rate, multiple drug-resistant bacteria infection rate, bath time consumption, and adverse reaction rate were compared between the two groups. Results: The hospital infection rate of the control group was 20.00% (29/145), the infection rate of patients was 37.93%(55/145), the infection rate of multiple drug-resistant bacteria was 25.52%(37/145), and the infection rate of the intervention group was 11.19% (15/134), 24.63% (33/134), 14.93% (20/134). The differences were statistically significant (χ²=4.065, 5.709, 4.806, P<0.05). The bath time of the control group was (16.70±1.42) minutes, and the intervention group was (14.07±1.53) minutes. Compared with the control group, the bath time of the intervention group was saved, and the difference was statistically significant (t=9.637, P<0.01).No discomfort symptoms such as disinfectant allergy were found in both groups. Conclusion The application of clohexidine 2% gluconate wet wipes in the wiping bath of patients after liver transplantation had a good effect, significantly reducing the hospital infection rate, saving the time of wiping bath.

Objective: To study the correlation between job satisfaction and work effectiveness of ICU specialist nurses, to clarify the baseline level and influence factors, to increase the efficiency and satisfaction of the work, and to stabilize the ICU nurse team, to improve the quality of care. Methods: The convenience sampling method was used to select 116 specialist nurses from the 3 three grade ICU hospitals in Guangzhou. Through the questionnaire survey of nurses′ general situation, work efficiency and job satisfaction, the methods of descriptive statistics, average number, standard deviation analysis, simple linear regression model analysis and multiple linear regression analysis were adopted to reveal the relationship between work effectiveness and job satisfaction of specialist nurses. Results: The overall empowerment of ICU specialist nurses was 3.37 ±0.68. In the 6 dimensions of work efficiency, the average score of formal authorization was the lowest (3.01±0.93) and that of informal authorization was the highest (3.73±0.77). Multiple linear regression analysis showed that job satisfaction of nurses increased linearly with the increase of the scores of formal authorization and informal authorization (t=2.32, 3.78,P < 0.05). The total score of satisfaction was 55.03± 8.30. The work status dimension score was 35.16± 5.94, in the middle level limit; the work interpersonal relationship dimension score was 19.87 ± 2.82, in the high level. The work status satisfaction lagged behind the work interpersonal relationship satisfaction. Simple linear regression model analysis showed that the total score of satisfaction increased linearly with the average score of work efficiency, showing a positive linear correlation (t=9.891,P < 0.01). The regression equation was: y=27.12+8.273. Conclusions Because of the linear positive correlation between job efficacy and total score of satisfaction, nursing administrators should fully grasp the various factors affecting job efficacy in clinical management, and take targeted measures to improve the work efficiency of ICU specialist nurses, and ultimately improve the job satisfaction of nurses.