Objective:To investigate the surgical situations and perioperative outcome of pancreaticoduodenectomy in Jiangsu Province and the influencing factors for postoperative 90-day mortality.Methods:The retrospective case-control study was conducted. The clinicopathological data of 2 886 patients who underwent pancreaticoduodenectomy in 21 large tertiary hospitals of Jiangsu Quality Control Center for Pancreatic Diseases, including The First Affiliated Hospital of Nanjing Medical University, from March 2021 to December 2022 were collected. There were 1 732 males and 1 154 females, aged 65(57,71)years. Under the framework of the Jiangsu Provincial Pancreatic Disease Quality Control Project, the Jiangsu Quality Control Center for Pancreatic Diseases adopted a multi-center registration research method to establish a provincial electronic database for pancrea-ticoduodenectomy. Observation indicators: (1) clinical characteristics; (2) intraoperative and post-operative conditions; (3) influencing factors for 90-day mortality after pancreaticoduodenectomy. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(IQR), and comparison between groups was conducted using the Mann-Whitney U test. Count data were expressed as absolute numbers or constituent ratio, and comparison between groups was conducted using the chi-square test, continuity correction chi-square test and Fisher exact probability. Maximal Youden index method was used to determine the cutoff value of continuous variables. Univariate analysis was performed using the corresponding statistical methods based on data types. Multivariate analysis was performed using the Logistic multiple regression model. Results:(1) Clinical characteristics. Of the 2 886 patients who underwent pancreaticoduodenectomy, there were 1 175 and 1 711 cases in 2021 and 2022, respectively. Of the 21 hospitals, 8 hospitals had an average annual surgical volume of <36 cases for pancreaticoduodenectomy, 10 hospitals had an average annual surgical volume of 36-119 cases, and 3 hospitals had an average annual surgical volume of ≥120 cases. There were 2 584 cases performed pancreaticoduodenectomy in thirteen hospitals with an average annual surgical volume of ≥36 cases, accounting for 89.536%(2 584/2 886)of the total cases. There were 1 357 cases performed pancrea-ticoduodenectomy in three hospitals with an average annual surgical volume of ≥120 cases, accounting for 47.020%(1 357/2 886) of the total cases. (2) Intraoperative and postoperative conditions. Of the 2 886 patients, the surgical approach was open surgery in 2 397 cases, minimally invasive surgery in 488 cases, and it is unknown in 1 case. The pylorus was preserved in 871 cases, not preserved in 1 952 cases, and it is unknown in 63 cases. Combined organ resection was performed in 305 cases (including vascular resection in 209 cases), not combined organ resection in 2 579 cases, and it is unknown in 2 cases. The operation time of 2 885 patients was 290(115)minutes, the volume of intra-operative blood loss of 2 882 patients was 240(250)mL, and the intraoperative blood transfusion rate of 2 880 patients was 27.153%(782/2 880). Of the 2 886 patients, the invasive treatment rate was 11.342%(327/2 883), the unplanned Intensive Care Unit (ICU) treatment rate was 3.087%(89/2 883), the reoperation rate was 1.590%(45/2 830), the duration of postoperative hospital stay was 17(11)days, the hospitalization mortality rate was 0.798%(23/2 882), and the failure rate of rescue data in 2 083 cases with severe complications was 6.529%(19/291). There were 2 477 patients receiving postoperative 90-day follow-up, with the 90-day mortality of 2.705%(67/2477). The total incidence rate of complication in 2 886 patients was 58.997%(1 423/2 412). The incidence rate of severe complication was 13.970%(291/2 083). The comprehensive complication index was 8.7(22.6) in 2 078 patients. (3) Influencing factors for 90-day mortality after pancreaticoduodenectomy. Results of multivariate analysis showed that age ≥ 70 years, postoperative invasive treatment, and unplanned ICU treatment were independent risk factors for 90-day mortality after pancreaticoduodenectomy ( odds ratio=2.403, 2.609, 16.141, 95% confidence interval as 1.281-4.510, 1.298-5.244, 7.119-36.596, P<0.05). Average annual surgical volume ≥36 cases in the hospital was an independent protective factor for 90-day mortality after pancreaticoduodenectomy ( odds ratio=0.368, 95% confidence interval as 0.168-0.808, P<0.05). Conclusions:Pancreaticoduodenectomy in Jiangsu Province is highly con-centrated in some hospitals, with a high incidence of postoperative complications, and the risk of postoperative 90-day mortality is significant higher than that of hospitallization mortality. Age ≥ 70 years, postoperative invasive treatment, and unplanned ICU treatment are independent risk factors for 90-day motality after pancreaticoduodenectomy, and average annual surgical volume ≥36 cases in the hospital is an independent protective factor.

Objective:To analyze the predictive value of echocardiography combined with diaphragmatic ultrasound on the outcome of removing machine for patients who underwent cardiac valve replacement for mechanical ventilation.Methods:Retrospectively,a total of 57 patients who adopt mechanical ventilation after underwent cardiac valve replacement in the First People's Hospital of Yibin from January 2022 to March 2023 were selected as the study subjects.According to the results of removing machine,the patients were divided into failed group(11 cases)and successful group(46 cases).All patients underwent echocardiography combined with diaphragmatic ultrasound examination.The indicators of echocardiography,included left ventricular ejection fractions(LVEF),right ventricular fractional area change(RVFAC)and systolic myocardial velocity(Sa),between different groups were compared.The early diastolic mitral annular tissue velocity(e')was recorded to calculate the ratio of early diastolic transmitral flow velocity(E)to e'(E/e'),and the indicators of echocardiography and diaphragmatic ultrasound.Logistic regression analysis was performed to analyze the factors affecting the failure of removing machine.Receiver operating characteristic(ROC)curve was drawn to evaluate the predictive values of echocardiography and diaphragmatic ultrasound indicators for the failure of removing machine in mechanical ventilation.Results:The differences of the differences of LVEF,RVFAC and Sa between failed group and successful group were no significant(P>0.05).The E/e'value of the successful group was 10.06±1.30,which was significantly lower than 12.69±2.96 of the failed group,and the difference was statistically significant(t=2.084,P＜0.05).The diaphragm thickening fraction(DTF)and diaphragm excursion(DE)values of the successful group were respectively 41.34±10.74 and 13.04±1.18,which were significantly higher than 19.67±5.37 and 11.27±0.94 of the failed group,respectively,and the differences between the two groups were statistically significant(t=2.148,2.776,P＜0.05).The results of logistic regression analysis showed that low expression of DTF and DE,as well as high expression of E/e',were all influence factors for the failure of removing machine for patients adopted mechanical ventilation after underwent cardiac valve replacement.The ROC results showed that the best cut-off value of the prediction model was 0.0893,and the area under curve(AUC)values were 0.713(95%CI:0.646～0.758),0.710(95%CI:0.651～0.779),0.752(95%CI:0.657～0.805)and 0.886(95%CI:0.782～0.991).Conclusion:The combination of echocardiography and diaphragm ultrasound has better prediction for the outcome of removing machine,which high higher clinical application value.

Objective:To explore the effect of communication competence and psychological resilience on job burnout among Operating Room nurses.Methods:From March to June 2023, randomized clustering sampling was used to select 138 registered Operating Room nurses from four ClassⅢ Grade A hospitals in Taizhou for investigation. The survey was conducted using the general information questionnaire, Operating Room Nurses' Job Stressor Scale, Chinese version of the Connor-Davidson Resilience Scale, Nurses' Clinic Communication Competence Scale, and Maslach Burnout Inventory-General Survey. Hierarchical linear regression analysis was used to explore the effects of communication competence and psychological resilience on job burnout among Operating Room nurses.Results:A total of 138 questionnaires were sent out, and 133 valid questionnaires were collected, with a valid response rate of 96.38% (133/138). Among 133 Operating Room nurses, the job burnout score was (56.35±9.28), and the communication competence, psychological resilience, and work stress scale scores were (196.71±18.92), (78.09±18.31), and (96.37±22.47), respectively. Pearson correlation showed that job burnout among Operating Room nurses was negatively correlated with psychological resilience ( r=-0.475, P<0.01) and communication competence ( r=-0.241, P<0.01), and positively correlated with work stress ( r=0.360, P<0.01). Hierarchical linear regression analysis showed that, after controlling for other variables, psychological resilience and communication competence were the influencing factors of job burnout among Operating Room nurses ( P<0.01), which could explain 17.70% of the variation. Conclusions:The level of job burnout among Operating Room nurses is relatively high, and psychological resilience and communication competence are independent influencing factors. Managers can provide psychological counseling and support services for Operating Room nurses, offer communication competence training programs, and prevent and reduce job burnout among Operating Room nurses.

Objective:To construct the evaluation index system of the core competence of neonatal specialist nurses, so as to provide reference for clinical training of neonatal specialist nurses.Methods:From January 2020, through literature review, theoretical analysis, interview, Delphi method and superiority chart, the evaluation index and weight of core competence of neonatal specialist nurses were determined.Results:Totally 28 experts in China were invited for 3 rounds of consultation. The effective recovery rate of the questionnaires was 93.33%(28/30) in the first round. The effective recovery rate of the questionnaires was 100.00%(28/28) in the second and third rounds. The authority coefficient of the experts was 0.85 in the third round. The Kendall′s coefficients of concordance of the first-level indexes, second-level indexes and third-level indexes were 0.150, 0.221 and 0.161, respectively. The final evaluation index system of the core competence of neonatal specialist nurses included 5 first-level indicators, 17 second-level indicators and 58 third-level indicators.Conclusions:The evaluation index system of the core competence of neonatal specialist nurses constructed in this study has certain scientific, reliable and clinical application value, which is conducive to the training of newborn specialized nurses in China.

Owing to the increasing incidence and prevalence of inflammatory bowel disease (IBD) worldwide, effective and safe treatments for IBD are urgently needed. Hydrogen sulfide (H₂S) is an endogenous gasotransmitter and plays an important role in inflammation. To date, H₂S-releasing agents are viewed as potential anti-inflammatory drugs. The slow-releasing H₂S donor 5-(4-hydroxyphenyl)-3H-1,2-dithiole-3-thione (ADT-OH), known as a potent therapeutic with chemopreventive and cytoprotective properties, has received attention recently. Here, we reported its anti-inflammatory effects on dextran sodium sulfate (DSS)-induced acute (7 days) and chronic (30 days) colitis. We found that ADT-OH effectively reduced the DSS-colitis clinical score and reversed the inflammation-induced shortening of colon length. Moreover, ADT-OH reduced intestinal inflammation by suppressing the nuclear factor kappa-B pathway. In vivo and in vitro results showed that ADT-OH decreased intestinal permeability by increasing the expression of zonula occludens-1 and occludin and blocking increases in myosin II regulatory light chain phosphorylation and epithelial myosin light chain kinase protein expression levels. In addition, ADT-OH restored intestinal microbiota dysbiosis characterized by the significantly increased abundance of Muribaculaceae and Alistipes and markedly decreased abundance of Helicobacter, Mucispirillum, Parasutterella, and Desulfovibrio. Transplanting ADT-OH-modulated microbiota can alleviate DSS-induced colitis and negatively regulate the expression of local and systemic proinflammatory cytokines. Collectively, ADT-OH is safe without any short-term (5 days) or long-term (30 days) toxicological adverse effects and can be used as an alternative therapeutic agent for IBD treatment.
Humans ; Mice ; Animals ; Gastrointestinal Microbiome ; Intestinal Barrier Function ; Mice, Inbred C57BL ; Colitis/metabolism* ; Inflammatory Bowel Diseases/drug therapy* ; Inflammation ; Anti-Inflammatory Agents/pharmacology* ; Disease Models, Animal

A 45-year-old male patient underwent craniotomy and biopsy for intracranial lesions. In order to prevent epilepsy, sodium valproate 800 mg dissolved in 0.9% sodium chloride injection 8 ml was injected intravenously after operation, and then the sodium valproate solution of this concentration was continuously pumped at a speed of 0.6 ml/h. One hour after administration, the serum lactate level of the patient increased gradually, reaching the highest level of 14.7 mmol/L, accompanied by metabolic acidosis and compensatory respiratory alkalosis, and with the lowest pH of 7.09 and the lowest base excess of -26.3. The patient fell into a coma. The hyperlactatemia and metabolic acidosis were considered to be related to sodium valproate. Sodium valproate was stopped, intravenous infusion of 5% sodium bicarbonate injection and blood purification were given at the same time. After 3 days, the lactate level of the patient returned to normal, metabolic acidosis was basically corrected, and his mind was clear.

A 45-year-old male patient underwent craniotomy and biopsy for intracranial lesions. In order to prevent epilepsy, sodium valproate 800 mg dissolved in 0.9% sodium chloride injection 8 ml was injected intravenously after operation, and then the sodium valproate solution of this concentration was continuously pumped at a speed of 0.6 ml/h. One hour after administration, the serum lactate level of the patient increased gradually, reaching the highest level of 14.7 mmol/L, accompanied by metabolic acidosis and compensatory respiratory alkalosis, and with the lowest pH of 7.09 and the lowest base excess of -26.3. The patient fell into a coma. The hyperlactatemia and metabolic acidosis were considered to be related to sodium valproate. Sodium valproate was stopped, intravenous infusion of 5% sodium bicarbonate injection and blood purification were given at the same time. After 3 days, the lactate level of the patient returned to normal, metabolic acidosis was basically corrected, and his mind was clear.

Objective To enhance oral tablets ward pharmacy inventory efficiency and improve the comprehensive quality of the pharmacist by QCC activities .Method Main factors to extend the ward pharmacy tablet counting time were analyzed through collecting the previous ward pharmacy tablet count time and account matching rate .According to the main problems , the strategies were found out to be implemented ,identify and evaluate the implementation result .Result In view of the oral medicine ward pharmacy inventory of the reasons for the low efficiency ,following measures should be taken :reducing oral drug dispensing station varieties ,finishing cargo ,strengthening personnel training ,changing inventory counting method and optimi-zation of inventory materials and re-enacted drugs location code and so on .Ward pharmacy tablet counting time reduce from 6 .5 hours to 3 hours (reducing by 53 .85% ) .Conclusion The QCC activities could significantly improve the oral medicine ward pharmacy inventory efficiency and comprehensive quality of pharmacists .

Objective To explore the lived study feeling and experience of nursing upgrade students during blended learning model so as to provide the evidence of reforming teaching model of nursing educators.Methods Phenomenological research of qualitative research was used.Four focus groups,25 upgrade nursing students were interviewed in-depth.Results Six themes were sublimated:relief the contradiction between work and study,promote communication in double interaction,improve self-learning ability,improve selfconfidence as learning controllability,online courses lack a sense of belonging,lack of skills support.Conclusions Blended learning model meets students,needs,provides students with personalized learning and improves comprehensive quality.However,the development of blended learning model in China is in the primary stage,we should combine conditions and reference foreign experience to develop it.

Objective To investigate the feasibility of detecting adverse drug event( ADE)using Global Trigger Tool( GTT)in Chinese medical institutions. Methods Discharged patients' records of the Xuanwu Hospital of Capital Medical University from January 1st to December 31st 1013 were collected. After sorting by discharged date,30 cases were selected in a half month period by a random sampling tool of Microsoft Excell1007 software. Unqualified cases were eliminated according to the inclusion criteria( patients aged 18 and over,one time admission in 1013,and hospitalization for more than 1 day)and exclusion criteria( patients in the Department of Obstetrics,Family Planning,Rehabilitation,Oncology,Pediatrics, and day-care ward). The 10 cases were reviewed every half a month in sequence of random sampling using 35 triggers,including laboratory indexes,antidotes,clinical symptoms,and treatment measures,that were identified by GTT recommendation,relevant foreign researches,and self-experience of Xuanwu Hospital of Capital Medical University. All cases were enrolled if the number of cases which met the inclusion criteria was less than 10. The cases in whom triggers could be detected were marked as the cases with positive triggers. The cases with positive triggers-related situations were further reviewed in order to identify or exclude ADE and then the identified ADEs were classified. The positive triggers and ADEs were analyzed by Microsoft Excell1007 software and the positive predictive values of positive triggers were calculated. Results Totally 465 cases were reviewed. Of them,156 were male and 109 female with the mean age of 57(19~91)years. The time of hospital stay was 1 to 37 days with the mean hospital stay of 10 days. Of the 465 patients,in 108 patients(44. 7%)positive triggers could be detected. Of all the 35 triggers,11 triggers(61. 9%)were positive referring to 341 times. There were 18 ADEs identified involving 16 patients and the detectable rate was 3. 4%(16/465). Of the 18 ADEs,13 ADEs had their corresponding triggers containing 8 triggers. The overall positive predictive value of 11 positive triggers was 3. 8%. The 18 ADEs included pneumonia (1 ADEs),liver injury(1 ADEs),chill(1 ADEs),skin rash(1 ADEs),antibiotic-associated diarrhea (1 ADE),headache(1 ADE),dizziness(1 ADE),nausea and vomiting(1 ADE),hypoglycemia (1 ADE),over-sedation(1 ADE),delirium(1 ADE),bleeding(1 ADE),leucopenia(1 ADE),and excitation(1 ADE). There were 14 ADEs of class E and 4 ADEs of class F in the 18 ADEs which referred to 11 drugs including 5 kinds of antibacterial agents, 3 kinds of blood system drugs, 3 kinds of psychotherapeutic agents,1 kinds of cardiovascular drugs,1 kinds of hormone drugs,1 kinds of Chinese patent medicines,1 kind of lipid drug,1 kind of drug acting bone metabolism,1 kind of antipyretic analgesic,and 1 kind of anesthetic. Conclusions GTT could help to early detect the signals of ADEs and provide the reference evidence of preventing drug risk. It is valuable that GTT is popularized and used in Chinese medical institutions.