Objective:To analysis the risk factors and safety of administration of norepinephrine (NE) via peripheral vein line (PVL) in patients with septic shock.Methods:A single-center retrospective study was conducted. According to the Lanzhou University Second Hospital information system (HIS) and nursing adverse events report cards, patients with septic shock administrated with NE via PVL to correct the hypotension from January 1st 2015 to December 31st, 2019 were enrolled. The patients' general information, placement location of peripheral venous catheter and venousneedle type, characteristics of NE usage and patient general condition when extravasation occurred were collected. The univariate analysis and Logistic regression were used to analyze risk factors associated with extravasation. Also, the receiver operator characteristic curve (ROC curve) was drawn, and the predictive value of risk factors for extravasation was analyzed.Results:A total of 1 022 cases with NE were enrolled. After a preliminary screening, a total of 910 cases with NE were used to correct low blood pressure, including 116 cases of peripheral venous infusion. The average age was (52.91±18.69) years old, with majority of female (77 cases, 66.4%). Basic diseases were mainly chronic obstructive pulmonary disease (COPD, 100 cases, 86.2%), followed by hypertension(91 cases, 78.4%), coronary heart disease (87 cases, 75.0%), type 2 diabetes (74 cases, 63.8%) respectively, the primary disease was septic shock in 109 cases (94.0%). A total of 147 peripheral venous catheters were inserted, and the most common site of puncture was the forearm [78.9% (116/147)], followed by the hand [12.2% (18/147)] and the median cubital vein [8.8% (13/147)]. 89.9% of the needles were 20 G in diameter, and 75 cases (64.7%) were converted to central venous catheters (CVC) during subsequent treatment due to continuous infusion of NE. Six patients (5.2%) had extravasation, the median time of extravasation was 29 (23-39) hours, and the median time of NE was 23 (11-53) hours, including 2 patients with an infusion concentration of 60 mg/L and 4 patients with an infusion concentration of 120 mg/L.The infusion speed was 0.5-1.0 μg·kg -1·min -1, and the average speed of infusion was (0.75±0.04) μg·kg -1·min -1 when extravasation. Univariate and binary Logistic regression analysis showed that the risk factors related to the occurrence of extravasation included: ① patient factors: the presence of basic diseases, hypertension [odds ratio ( OR) = 3.11, 95% confidence interval (95% CI) was 3.09-3.12, P = 0.001] and edema ( OR = 1.79, 95% CI was 1.32-2.99, P = 0.032). ② Factors of infusion fluid itself: long-term (> 24 hours) infusion ( OR = 2.91, 95% CI was 1.04-5.96, P = 0.040), infusion concentration > 60 mg/L ( OR = 1.88, 95% CI was 1.32-3.99, P = 0.024), infusion speed > 0.3 μg·kg -1·min -1 ( OR = 2.43, 95% CI was 2.38-2.51, P = 0.029) and diameter of needles < 20 G ( OR = 3.11, 95% CI was 3.09-3.22, P = 0.033).③ Medical personnel factors: lack of observation and assessment ( OR = 1.09, 95% CI was 1.03-6.77, P = 0.043). The ROC curve analysis showed that: edema, long-term infusion (> 24 hours), infusion rate > 0.3 μg·kg -1·min -1and diameter of needles < 20 G had a certain predictive value for extravasation of NE through peripheral venous infusion in patients with septic shock, the area under ROC curve (AUC) was 0.610, 0.762, 0.672, 0.629, 95% CI was 0.508-0.713, 0.675-0.849, 0.571-0.772, 0.525-0.732, and P values were 0.044, 0.000, 0.002, 0.019, respectively. Conclusions:Hypertension, edema, long-term infusion (> 24 hours), infusion concentration > 60 mg/L, infusion speed > 0.3 μg·kg -1·min -1, diameter of needle < 20 G, and lack of observation and evaluation by medical staff regularly were risk factors affecting the safety of peripheral intravenous NE in patients with septic shock. Peripheral NE should be avoided in the presence of the above risk factors.

Objective To explore the effect of mobile internet management in continuing nursing care of premature infants. Methods The convenience sampling method was adopted to divide the premature infants from January to December in the year 2015 into 2 groups according to the time order, the control group (n = 56), and the observation group (n = 57). The control group received continuing nursing care for the whole course from admission to discharge. Based on the nursing care of the control group, the observation group were given an extra continuing nursing care by using the mobile internet. Both group's continuing nursing care were lasted from the birth till 12 month.Comparisons of two groups were made from the following aspects: of preterm infants born at 12 months in the length, weight, head circumference of the preterm infants at 12 months old and 40 weeks corrected gestational age Neonatal Behavioral Neurological Assessment,breastfeeding confidence;parents care knowledge scores at the time of admission, discharge and 1month after discharge; referral rate; parents satisfaction at the time of discharge and the end of extended care). Results In the observation group,the length,weight and head circumference of the preterm infants at birth were(74.10 ± 2.66)cm,(8.70 ± 1.43)kg,(45.40 ± 1.38)cm, Neonatal Behavioral Neurological Assessment at 40 weeks of gestation,self-confidence in breastfeeding,1 post-discharge and 1 post-discharge parents care knowledge score of the month, parents of preterm children satisfaction scores, respectively(37.30 ± 3.22),(120.31 ± 13.65),(82.28 ± 3.99, 96.70 ± 2.28), (93.55±2.91,96.61±2.37),the control group were(73.20±2.80)cm,(8.44±1.02)kg,(44.2±1.40)cm, (36.00±2.87),(114.54±12.21),(80.66±3.51, 95.02±3.87),(92.57±2.41, 95.72±2.02). The difference between the two groups was statistically significant(t=-5.244~-2.014,all P<0.05). Conclusions The mobile internet application of continuing nursing care in premature infants can improve the growth and development of premature infants and maternal breastfeeding confidence,promote parents care knowledge, referral rate and satisfaction,thus guarantee the he living quality of the preterm infants.

Objective To investigate the expressions of octamer-binding transcription factor 4 (Oct4) and phosphorylated-protein kinase B (p-Akt) proteins in colorectal cancer and their clinical significances, in order to explore the roles of Oct4 and p-Akt in the staging and grading of colorectal cancer. Methods Immunohistochemical technique was used to examine the expression of Oct4 and p-Akt proteins in 78 cases of colorectal cancer in Wuxi Second Hospital of Traditional Chinese Medicine and Wuxi First People's Hospital from January 2011 to December 2016. Relationship between expressions of Oct4 and p-Akt proteins and clinicopathological parameters were analyzed. Results The positive rate of Oct4 in tumors was 74.36 % (58/78), which was obviously higher than that in normal tissues [35.90 % (20/78), χ2= 23.32, P < 0.01]; and the positive rate of p-Akt in tumors was 67.95 % (53/78), which was obviously higher than that in normal tissues[28.21 %(25/78),χ2=24.68,P <0.01].The double positive and negative expression rate of these two proteins accounted for 80.8 %(63/78), with a linear positive correlation (r= 0.455, P < 0.000 1). In 78 cases of colorectal cancer, the expression of Oct4 protein was correlated with histological grade, lymph node metastasis, and Duke staging (all P < 0.05), and the expression of p-Akt protein was correlated with histological grade and lymph node metastasis (both P < 0.05). The multivariate logistic regression analysis showed that the expression of Oct4 protein was related to histological grade and Duke staging(both P<0.05),and the expression of p-Akt protein was only related to lymph node metastasis (P<0.05). Conclusion The combined detection of Oct4 protein and p-Akt protein has reliable and important clinical significance for judging the histological grade,lymph node metastasis and Duke staging of colorectal cancer.

Objective:To evaluate the efficacy and safety of microemulsified cyclosporine(Neoral)and tacrolimus(FK506) for immunodepression after Iiver transplantation.Methods:According to the including criteria,fifteen randomized controlled trials were enrolled in this analysis.The data of trial design,characteristics of the subjects,and findings of the studies were reviewed and analyzed by RevMan 4.2.8 software.Results:The patient survival rate,graft survival rate,incidence of nephrotoxicity,and incidence of infection were not significantly different between Neoral and FK506 groups,with the relative risk and(95% CI,P)being 0.99(0.96-1.02,0.37),0.97(0.92-1.03,0.30),0.99(0.87-1.13,0.86)and 1.08(0.97-1.20, 0.16),respectively.The incidences of hypertension(1.34[1.15-1.55,0.000 1])and acute rejection(1.15[1.06-1.25,0.001]) were significantly lower in the FK506 group,with no significant difference found in the degree of acute rejection(1.00[0.92- 1.22],0.98).Interestingly,the incidence of diabetes was significantly higher in the FK506 group within 1 year after the operation,but was similar to that of the Neoral group thereafter,with relative risk(95%CI,P)being 0.72(0.62-0.83,

Objective To explore the postoperative psychological status of donors during pediatric living donor liver transplantation (LDLT) to elucidate the correlation between resilience,anxiety and depression.Methods Random sampling was employed for selecting 60 pediatric LDLT donors undergoing LDLT from September 2014 to February 2019.They were requested to answer a questionnaire.The questionnaire concluded general information,self-rating anxiety scale (SAS),selfrating depression scale (SDS) and Chinese version of Resilience Scale.Results The score of anxiety was (46.06 ± 10.06) and depression was (50.32 ± 11.49).Both values were higher than those of Chinese norm.The score of resilience was (59.55 ± 14.62).And the total score of resilience and the score of each dimension were negatively correlated with anxiety and depression (P＜0.01).Conclusions The postoperative anxiety and depression level of donors during LDLT are higher than the ordinary.Resilience is negatively correlated with the level of anxiety and depression.The lower level of resilience,the higher anxiety and depression of donors during LDLT.For clinicians,appropriate intervention measures should be taken for improving the resilience,reducing negative emotions and boosting the quality-of-life of donors during LDLT.