Objective To study the mechanism of p55 inducing cell apoptosis, the 180 bp fragment of Puma promoter was cloned into the pGL3-basic luciferase reporter vector. The biological activity of Pumareporter plasmid was verified by cell transfection. Methods The target fragments of Puma were amplified by RT-PCR method and the fragments were inserted into the pGL3-basic luciferase reporter vector. The acquired Puma-Luc plasmid was transfected into H1299 cell line and detected its activity. Results Sequencing indicated that the amplified Puma promoter is correct. Dual-luciferase Reporter Assay showed the Puma-Luc constructs have promoter activity. Conclusion The cloning of human Puma gene promoter and the construction of its reporter vector were successful. This study will lay the foundation for further research on the function of p53 inducing apoptosis through mitochondrial pathway.

Objective Construct the eukaryotic expression vector of inhibitory member of the ASPP family (iASPP) and trans-fect it into colon carcinoma cell lines SW480 and Lovo by liposome .Then observe the expression of iASPP and detect the cell apop-tosis by flow cytometry .Methods The amplified PCR product was digested and inserted into pMD19-T simple vector and sub-cloned into eukaryotic expression vector pcDNA3 .1(+ ) .The recombinant eukaryotic expression plasmid pcDNA3 .1(+ )-iASPP was transfected into colon carcinoma cell lines SW480 and Lovo by liposome ,the iASPP expression was analyzed by RT-PCR .The cell apoptosis was detected by FCM .Results The eukaryotic expression plasmid pcDNA3 .1(+ )-iASPP was constructed success-fully ,the gene squence of iASPP was consistent with that reported (gi 60457962) in GenBank .The mRNA expression levels of iASPP gene of SW480 and Lovo cell lines which transfect the positive plasmid were increased ,and the cell apoptosis rates were de-creased .Conclusion We successfully constructed the recombinant expression plasmid pcDNA 3 .1(+ )-iASPP ,and the plasmid were successfully expressed in colon carcinoma cell lines SW 480 and Lovo ,the cell apoptosis rates of those cell lines were decreased .These facts indicated that reducing the high expression of iASPP may be a new strategy to renew the abilities of P 53 tumor suppressor .

Objective: To explore the effect of early enteral nutrition(EEN) and parenteral nutrition(PN) on the postoperative outcomes of patients with gastric cancer and nutritional risk in enhanced recovery after surgery. Methods: A total of 130 patients with gastric cancer hospitalized in department of surgery of Ningbo First Hospitalfrom September 2016 to May 2018 were selected and divided into early enteral nutrition support group (EEN) which was placed with jejunal nutrition tube during the operation, and enteral nutrition started within 12-24 hours after the operation, and parenteral nutrition support group (PN) which was given parenteral nutrition support one day after surgery. Patients in both groups were given nutrients of equal heat and nitrogen.The incidence of nutrition-related complications, the incidence of infection-related complications, the length of postoperative hospital stay and the time of anal exhaust were compared between the two groups. Results: The incidence of nutrition-related complications was 10 cases (15.38%) and 4 cases (6.15%)in EEN group and PN group, that was not statistically different (P=0.157). The incidence of infection-related complications was 3 cases (4.61%) and 5 cases (7.69%) in EEN group and PN group, that was not statistically different (P=0.715). The postoperative hospital stay was 11 days (range, 10-15) and 12 days (range, 11-13)in EEN group and PN group, that was not statistically different (P=0.233). The first anal exhaust time and defecation timewere 64 hours (range, 52-77) and 87 hours (range, 76-100) in EEN group and 72 hours(range, 60-86) and 96 hours(range, 86-120) in PN group, that was statistically different(P=0.001, P=0.034). Conclusion Enhanced recovery after surgery, early enteral nutrition after gastric cancer surgery may promote the recovery of intestinal function, but the complications and hospital stay after operation are not improved.

Objective:To investigate the effect of sarcopenia on physical performance and nutritional status in elderly patients with gastrointestinal tumors.Methods:a total of 120 eligible in-patients were enrolled from gastrointestinal surgery department of a Grade A tertiary hospital in Ningbo city from September 2021 to January 2022. General clinical data were collected, nutritional risk was screened using Nutritional Risk Screening 2002 (NRS 2002), physical performance was assessed by Short Physical Performance Battery (SPPB), skeletal muscle index at the third lumbar vertebra level (L3 SMI) was calculated using abdominal CT scan, and grip strength/muscle strength, gait speed by 6 Meter Timed Walk Test and calf circumference were measured. Subjects were divided into sarcopenia and non-sarcopenia group according to the diagnostic criteria of the Asian Working Group for Sarcopenia (AWGS). Impacting factors of sarcopenia and the correlation between muscle mass and physical performance in elderly patients with gastrointestinal tumors were analyzed.Results:The overall prevalence rate of sarcopenia in elderly patients with gastrointestinal tumors was 28.3% (34/120) and it was 28.9% (22/76) and 27.3% (12/44) in males and females respectively. There were statistically significant differences in age, tumor stage, nutritional risk, body mass index, calf circumference, L3 SMI, grip strength/muscle strength, gait speed and SPPB score between patients with and without sarcopenia (P<0.05). Muscle strength/grip strength, L3 SMI and gait speed were closely correlated with the occurrence of sarcopenia in elderly patients with gastrointestinal tumors (P<0.05). The L3 SMI was positively correlated with physical performance as assessed with SPPB in both groups.Conclusions:Sarcopenia is a common complication in elderly patients with gastrointestinal tumors with multiple influencing factors. Timely nutritional intervention and exercise intervention should be incorporated into the treatment of elderly gastrointestinal tumor patients with sarcopenia in order to improve nutrition status.

Objective To explore the clinical effect of applying standard process management in early enteral nutrition support for elderly patients with gastric cancer after operation. Methods A total of142 elderly patients with gastric cancer in our hospital were randomly divided into control group ( n=71) treated with the traditional nursing of enteral nutrition and intervention group ( n=71) adopting the standardized process man-agement, and then enteral nutrition tolerance, complications, nutritional status and recovery of gastrointestinal function were compared between the two groups. Results There was no significant difference in age, sex and preoperative nutritional condition and operation situation between the two groups ( P>0. 05) . The incidence of nutritional intolerance and the cost of nutritional support were lower than those in the control group ( P<0. 05) . The completion rate of enteral nutrition target in the intervention group was significantly higher than that in the control group ( P<0. 05) . The anal exsufflation time and defecation time of patients in the intervention group were shorter than those in the control group ( P<0. 05) . There was no significant difference in pulmonary infec-tion, incision infection and postoperative hospital stay between the two groups ( P>0. 05 ) . Conclusions Standardized process management of early enteral nutrition after operation could significantly improve the toler-ance of enteral nutrition, meanwhile, it has positive significance in promoting rapid recovery of elderly patients with gastric cancer.

Objective? To construct a nursing intervention model based on the theory of planned behavio(r TPB), to prevent deep venous thrombosis (DVT) of lower extremities, and to explore its application in patients with gastrointestinal cancer after operation. Methods? By convenience sampling, a total of 163 patients admitted in the Department of Gastrointestinal Surgery, Ningbo First Hospital, Zhejiang Province who underwent gastrointestinal surgeries from January to December in 2018 were selected as the research objects in this study. The 79 patients admitted from January to June in 2018 were taken as the control group and the conventional perioperative DVT prevention nursing care was given. The other 84 patients admitted from July to December in 2018 were taken as the observation group and the TPB based DVT nursing intervention model was adopted. The two groups were compared in terms of the patient's scores in cognition about DVT, postoperative ankle pump movement, quadriceps femoris movement, first out-of-bed activity within 24 hours and compliance with walking target volume within 3 days after surgery, as well as the number of cases of DVT during hospitalization after surgery. Results? The score of DVT knowledge in the observation group was higher than that in the control group; the compliance of ankle pump movement, quadriceps femoris movement and the proportion of patients getting out of bed for the first time within 24 hours after operation in the observation group were higher than those in the control group; the differences between the two groups were statistically significant (P＜0.05). The rate of achieving 500 m walking goal in the observation group was higher than that in the control group 3 days after operation, but there was no significant difference between the two groups (P＞0.05). There were 7 cases of DVT in control group and 1 case in observation group after operation, and there was statistically significant difference between the two groups (P＜0.05). Conclusions? The DVT nursing intervention model based on TPB is helpful to improve the cognitive level of DVT in patients undergoing gastrointestinal cancer surgery, improve the compliance of lower limb activities and early ambulation, and reduce the incidence of DVT after surgery, establish good healthy behavior for patients undergoing gastrointestinal cancer surgery and effectively prevent DVT.

Objective To explore the effects of project-achieving quality control circle (QCC) in day surgery nursing optimization model so as to provide a theoretical support for hospital day surgery nursing management and process improvement. Methods A total of 119 patients with day surgery in April 2018 and 170 in November 2018 at Ningbo First Hospital of Zhejiang Province were selected as subjects. This study developed activities based on the QCC activity theme of "Construction of Day Surgery Nursing Management Model by Various Measures", plan-do-check-action (PDCA) cycle and 10 steps of project-achieving QCC. Before and after optimizing process, the field follow-up for patients was carried out by telephone follow-up and questionnaire investigation, and tangible results (satisfaction of pre-hospital service, completion rate of follow-up, score of patients' continuous nursing needs, satisfaction with day surgery) as well as intangible results (skill application, teamwork, communication and coordination, computer application, activity confidence and activity participation) were evaluated. Results Patient's satisfaction of pre-hospital service raised from 52.1% to 82.4% before and after optimizing process; the rate of follow-up increased from 35.3% to 97.0%; patient's satisfaction with day surgery raised from 40.3% to 82.9%; the score of continuous nursing needs decreased from (20.90±12.91) to (17.59±11.78); the differences were all statistically significant (P＜ 0.05). The intangible results also improved, such as skill application of members in QCC. Conclusions The project-achieving QCC based day surgery nursing optimization model improves the completion rate of follow-up in nurses and patient satisfaction, and lowers patients' needs for continuous nursing and increases nursing team cohesion.

Objective:To deeply understand the reason and inner experience of day surgery patients canceling surgery through qualitative research, so as to strengthen the management of day surgery patients.Methods:This research adopted phenomenological research method. From June to December 2019, purpose sampling was used to select 12 patients who had canceled the day surgery at Ningbo First Hospital in Zhejiang Province for a semi-structured interview. The Colaizzi 7-step analysis method was used for data analysis.Results:Through repeated refining, analysis and extraction of interview data, the reasons and inner experience of day surgery patients who canceled surgery were finally summarized into 5 themes. Those themes included fear of day surgery, distrust of day doctors, affected by basic diseases and physiological factors, lack of confidence in community medical care, insufficient preparation before surgery.Conclusions:The reasons for day surgery patients to cancel surgery include fear of surgery, distrust of doctors, basic diseases and physiological factors, lack of confidence in community medical care, and insufficient preparation before surgery. It is recommended that day surgery medical and nursing staff strengthen day ward management, improve their professional level and ability to communicate with patients, and at the same time promote the construction of hospital-community integration to ensure the medical safety of patients after discharge from the hospital, and further reduce the cancellation rate of day surgery.

Objective:To investigate the relationship between discharge readiness and nutritional status of patients undergoing gastric cancer surgery in the context of enhanced recovery after surgery (ERAS) , so as to provide individualized guidance for patients after discharge.Methods:Using the convenient sampling method, a total of 120 patients who underwent radical gastrectomy for gastric cancer from June 2020 to June 2021 in Ningbo First Hospital were selected as research objects, and they all received ERAS nursing care. One day before discharge, Nutritional Risk Screening Table and Discharge Readiness Scale were used for questionnaire analysis.Results:The total score of discharge readiness of 120 patients with gastric cancer after surgery was (81.42±6.87) . Among the three dimensions, personal status was (19.65±2.19) , adaptability was (29.67±3.10) and anticipatory support was (32.10±2.61) . 57.5% (69/120) of gastric cancer patients discharged from hospital had nutritional risk. The scores of hospital discharge readiness and the scores of each dimension in the nutritional risk group were lower than those in the non-nutritional risk group, and the differences were statistically significant ( P<0.05) . Multivariate analysis showed that nutritional status was an influencing factor for the total score of hospital discharge readiness in patients with gastric cancer surgery (standardized regression coefficient was 0.321, P<0.05) . Conclusions:Under the background of ERAS, the discharge readiness of patients after gastric cancer surgery is at a moderate level, postoperative patients are generally at nutritional risk and the discharge readiness of patients with nutritional risk is lower than that of patients without nutritional risk. Perioperative nutrition management by nursing staff can improve the discharge readiness of patients undergoing gastric cancer surgery, and continuous nutrition management should be carried out for discharged patients with nutritional risk, in order to promote home rehabilitation of patients with gastric cancer surgery.

Objective:To explore the nutritional status and quality of life of gastric cancer patients one month after operation in the context of enhanced recovery, and analyze the correlation between them.Methods:From August 2020 to August 2021, 168 patients discharged from the Gastrointestinal Surgery of Ningbo First Hospital after radical resection of gastric cancer were selected as the study subject by convenience sampling. The Nutritional Risking Screening 2002 (NRS2002) and the Global Leadership Initiative on Malnutrition (GLIM) step 2 (excluding muscle mass measurement index) were used to assess the postoperative nutritional status of patients. The quality of life of patients with gastric cancer after operation was investigated with the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30) . Logistic regression analysis was used to explore the influencing factors of nutritional status of postoperative patients with gastric cancer. A total of 168 questionnaires were distributed, and 168 valid questionnaires were recovered, with a valid recovery rate of 100.0%.Results:A total of 104 patients (61.9%) had nutritional risk and 46 patients (27.4%) had malnutrition. There were statistical differences in age, education level, tumor stage, body mass index, physical function, role function, emotional function, cognitive function, general health, fatigue, nausea and vomiting, and loss of appetite among gastric cancer patients with different nutritional status after operation ( P<0.05) . Logistic regression analysis showed that body mass index, physical function, role function, emotional function and fatigue were the influencing factors of the nutritional status of patients one month after operation ( P<0.05) . Conclusions:In the context of enhanced recovery, the nutritional risk and malnutrition rate of gastric cancer patients one month after operation are high, and are closely related to the quality of life. When implementing enhanced recovery after surgery, medical and nursing staff should strengthen and optimize the nutrition management of gastric cancer patients before hospital, during perioperative period and after discharge, improve the nutritional status after operation and the quality of life of patients.