Objective To construct quality evaluation indicators for perioperative nursing in heart transplantation,and to provide standard and professional quantitative bases for monitoring and management of perioperative nursing quality.Methods This study was conducted based on the frame work of the three-dimensional"structure-process-outcome"quality model,using literature review,Delphi method and analytic hierarchy to determine the content of the indicators,and the weight of each index.Results A total of 22 experts from 14 qualified heart transplantation hospitals were included,and a total of 2 rounds of consultations were conducted.The effective recovery rates of 2 rounds of expert consultation questionnaires were 100％.The authority coefficients were 0.817.The variation coefficients of each item ranged from 0.025～0.169 and 0.039～0.157.The Kendall harmony coefficients were 0.126 and 0.225(P＜0.001).The final evaluation indicators for perioperative nursing quality in heart transplantation included 3 first-level indicators,12 second-lever indicators and 59 third-level indicators.Conclusion The evaluation indicators of perioperative nursing quality in heart transplantation was scientific,comprehensive and specialized,which can provide references for the evaluation of perioperative nursing quality in heart transplantation.

Objective:To analyze the effectiveness and safety of the second course radiotherapy for unresectable colorectal cancer liver metastases.Methods:We retrospectively collected the data of 28 patients with unresectable colorectal cancer liver metastases who received the second course radiotherapy at Peking University Cancer Hospital and Institute from 2017 to 2023, to analyze the feasibility of re-irradiation.Results:For the 28 patients, the median follow-up time after re-irradiation was 20.2 months. The median time interval between the first- and second-course radiotherapy was 11.1 months. The median biologically effective doses of the first- and second-course radiotherapy were 100 Gy and 96 Gy, respectively. Stereotactic body radiotherapy was administered to 25 patients (89.3%) during the first course and 24 patients (85.7%) during the second course of radiotherapy. The mean equivalent dose in 2 Gy fractions to the normal liver was 10.1 Gy in the first-course radiotherapy and 7.9 Gy in the second-course radiotherapy. The complete response rate, partial response rate, and objective response rate after re-irradiation were 54.5%, 18.2%, and 72.7%, respectively. After re-irradiation, the 2-year cumulative local failure rate was 17.0% when calculated based on patients and 15.1% when calculated based on lesions, the 1-year progression-free survival rate was 27.4%, and the 3-year overall survival rate was 46.7%. The second-course radiotherapy was well tolerated, with most patients (75.0%) experiencing grade 1-2 acute adverse reactions and only one case (3.6%) experiencing grade 3 acute adverse events.Conclusions:Second course radiotherapy is an effective and safe treatment approach for selected patients with unresectable colorectal cancer liver metastases.

Objective:To evaluate the effects of dexmedetomidine on the enhancement of fear memory by propofol in rats with post-traumatic stress disorder (PTSD).Methods:Two hundred and twenty clean-grade healthy male Sprague-Dawley rats, weighing 300-400 g, aged 12-16 weeks, underwent conditioned fear memory training, and PTSD model was developed.One hundred and twenty rats were divided into 6 groups ( n=20 each) by a random number table method: control group (C group), PTSD group, propofol group (P1 group), and propofol + different doses of dexmedetomidine groups (P1+ DEX10 group, P1+ DEX20 group and P1+ DEX40 group). In group C, only sound was played and no electric shock was given during conditioned fear memory training.After conditioned fear memory training, sesame oil 1 ml/kg was intraperitoneally injected in PTSD group, propofol 1 ml/kg was intraperitoneally injected in group P1, and dexmedetomidine 10, 20 and 40 μg/kg were intraperitoneally injected in P1+ DEX10, P1+ DEX20 and P1+ DEX40 groups, respectively.After drug administration, conditioned fear memory test was performed to record the time of rigid behavior within 90 s, and the percentage of time of rigid behavior was calculated.The development of SpO 2<90% was recorded during administration.One hundred Sprague-Dawley rats were divided into 5 groups ( n=20 each) by the random number table method: propofol group (P2 group), and propofol+ dexmedetomidine given at different timings groups (P2+ DEX T0 group, P2+ DEX T30 group, P2+ DEX T60 group and P2+ DEX T90 group). After the conditioned fear memory training, propofol 1 ml/kg was intraperitoneally injected in 5 groups, an then dexmedetomidine 20 μg/kg was intraperitoneally injected at 0, 30, 60 and 90 min after propofol administration in P2+ DEX T0, P2+ DEX T30, P2+ DEX T60 and P2+ DEX T90 groups, respectively.Conditioned fear memory test was performed after drug administration to record the time of rigid behavior within 90 s, and the percentage of time of rigid behavior was calculated. Results:Only 6 rats developed SpO 2<90% during the administration period in P1+ DEX40 group.Compared with C group, the percentage of time of rigid behavior was significantly increased in PTSD group ( P<0.05). Compared with PTSD group, the percentage of time of rigid behavior was significantly increased in P1 group ( P<0.05). Compared with P1 group, the percentage of time of rigid behavior was significantly decreased in P1+ DEX20 and P1+ DEX40 groups ( P<0.05), and no significant change was found in the percentage of time of rigid behavior in P1+ DEX10 group ( P>0.05). Compared with P2 group, the percentage of time of rigid behavior was significantly decreased in P2+ DEX T0 and P2+ DEX T30 groups ( P<0.05), and no significant change was found in the percentage of time of rigid behavior in P2+ DEX T60 and P2+ DEX T90 groups ( P>0.05). Conclusions:Dexmedetomidine can attenuate propofol-induced enhancement of fear memory in a rat model of PTSD, and the best effect is achieved in early administration of moderate dose (20 μg/kg, within 30 min after propofol administration).

Objective:To screen the risk factors for post-traumatic stress disorder (PTSD) after emergency trauma surgery in the patients.Methods:The medical records of emergency surgical trauma patients (traffic accident, fall, engineering accident, etc.) were retrospectively collected.The general condition and perioperative clinical indicators of the patients were recorded.The patients were divided into PTSD group and non-PTSD group according to whether PTSD occurred within 1 month after surgery.Multivariate logistic regression analysis was used to screen the risk factors for PTSD.Results:A total of 312 patients were enrolled, and the incidence of PTSD at 1 month after surgery was 19.9%.There were significant differences in preoperative VAS score, ratio of gender, intraoperative use of propofol, intraoperative use of dexmedetomidine, and postoperative ICU transfer rate between PTSD group and non-PTSD group ( P<0.05). The results of logistic regression analysis showed that intraoperative use of propofol, preoperative high VAS score and postoperative admission to ICU were independent risk factors for PTSD, and intraoperative use of dexmedetomidine was a protective factor for the prevention of PTSD ( P<0.05). Conclusions:Intraoperative use of propofol, preoperative high VAS score and postoperative transfer to ICU are independent risk factors for postoperative PTSD in the patients with emergency trauma, and intraoperative use of dexmedetomidine is a protective factor for the prevention of PTSD.

Objective:To evaluate the effect of preoperative cognitive behavioral therapy (CBT) on pain catastrophizing in the patients with orthopedic trauma.Methods:A total of 120 patients with lower extremity bone trauma, aged 18-64 yr, of American Society of Anesthesiologists physical status Ⅰor Ⅱ, with body mass index of 18-28 kg/m 2, with Pain Catastrophic Scale (PCS) score on admission >16, scheduled for surgical treatment, were enrolled.The patients were divided into 2 groups ( n=60 each) by the stratified randomization method based on the type of fracture: CBT group and routine group (group R). Group CBT received CBT for pain through the internet on the day of admission and one day before operation.The patients in both groups underwent reduction and internal fixation of lower extremity fractures under combined spinal-epidural anesthesia.The PCS scores were recorded immediately after admission and on the morning of the operation day.The effective pressing times of the patient-controlled analgesia pump, consumption of analgesics for rescue analgesia, and occurrence of nausea and vomiting within 48 h after operation were recorded.The visual analogue scale score of the surgical site during activity and occurrence of the score >3 at 3 months after operation and use of opioids within 3 months after operation were recorded. Results:Compared with group R, the PCS score was significantly decreased on the morning of the operation day, the pressing times of the patient-controlled analgesia pump, consumption of analgesics for rescue analgesia and incidence of nausea and vomiting within 48 h after operation were decreased, the requirement for opioids within 3 months after operation was decreased ( P<0.05), and no significant change was found in VAS score during activity and occurrence of the score >3 at 3 months after operation in group CBT ( P>0.05). Conclusions:Preoperative CBT can reduce the degree of pain catastrophizing and is helpful in increasing the quality of postoperative analgesia in the patients with orthopedic trauma.

Objective:To investigate the effects of propofol and sevoflurane on post-traumatic stress disorder (PTSD) after emergency surgery in trauma patients.Methods:A total of 160 trauma patients undergoing emergency surgery under general anesthesia were randomly divided into the propofol group and the sevoflurane group. The perioperative clinical data of the two groups were collected. The incidence of PTSD was evaluated by PCL-5 score one month after the operation in the two groups. The relevance of the injury time and PCL-5 score was assessed by Spearman correlation analysis. Logistic regression analysis was used to analyze the risk factors of PTSD.Results:The incidence of PTSD in the propofol group was significantly higher than that in the sevoflurane group at postoperative 1 month (24.0% vs 10.8%, P=0.034). The injury time was negatively correlated with PCL-5 score in the propofol group ( r=0.229, P<0.01). There was no correlation between the injury time and the PCL-5 score in the sevoflurane group ( r=0.001, P=0.804). Logistic regression analysis showed that the use of propofol was an independent risk factor for PTSD ( P=0.004). Conclusions:Sevoflurane anesthesia is more effective than propofol anesthesia in reducing the occurrence of PTSD in emergency surgery for trauma patients.

Objective:To summarize the nursing points of emergency heart transplantation in an elderly patient with fulminant myocarditis and acute myocardial infarction.Methods:Hemorrhage early warning care, cyclic goal-oriented care, rejection and staged care, infection prevention and control care, difficult ventilator weaning care, and individualized rehabilitation care were provided to elderly patient with fulminant myocarditis and acute myocardial infarction after emergency heart transplantation in July 2020 in the First Hospital Affiliated to Zhejiang University and the effects were observed.Results:The patient's heart function recovered well after the transplantation, and no rejection reaction occurred. Before discharge, the patient was clear, active and optimistic, eating on his own, walking 300 meters in 6 minutes, and the vital signs were stable. One month after discharge, the patient was followed up to take care of himself and was in a stable mood.Conclusions:Carrying out bleeding prevention, circulatory care, rejection care, infection prevention and control care, ventilator difficulty weaning care and individualized rehabilitation care for elderly patients with fulminant myocarditis and acute myocardial infarction after emergency heart transplantation are effective means to ensure the success of the operation and the recovery of patients after the operation.

Objective To investigate the efficacy of concurrent chemoradiotherapy for anal squamous cell carcinoma (ASCC) in the era of intensity-modulated radiotherapy.Methods A total of 19 patients with ASCC who underwent definitive radiotherapy in our hospital since 2011 were collected.The survival curves were depicted with K-M method.Risk factors of disease progression were analyzed using case-control study.Results The median follow-up time was 31 months.The 3 year-LFS and 3 year-OS were 88.1％ and 91.7％,respectively.Grade 3 acute toxicities during the chemoradiotherapy were mainly white blood cell reduction (15.8％),platelet reduction (10.5％),diarrhea (15.8％),and skin reaction (31.6％).Compared with historical data,volumetric intensity modulated arc therapy was superior to conventional radiotherapy in the treatment outcome and normal tissue protection in ASCC.Univariate analysis showed that concurrent chemotherapy with capecitabine was a favorable factor in disease progression (P＜ 0.05).Conclusions Volumetric intensity modulated arc therapy for ASCC may have advantages in terms of efficacy and normal tissue protection.Concurrent chemotherapy with a double-drug regimen containing capecitabine may be a beneficial factor in disease progression.

Objective To explore the value of MRI simulation in the pre-operative radiotherapy for locally advanced low rectal carcinoma.Methods A total of 40 patients diagnosed with locally advanced low rectal carcinoma by endoscopic biopsy and radiological staging examinations were included in this study.There were 22 male and 18 female with nedian age 58 years (range 31-80).Patients underwent CT and MRI simulation scanning in the same position and fixing device.GTV under CT images and MRI inages were delineated respectively by two experienced radiologists.Primary tumor length,tumor volume and distance of distal tumor from the anal verge were calculated by treatment planning system(TPS).The two groups of data were compared.Results The distance of distal tumor to the anal verge were all no more than 5 cm on digital examination.The mean length of GTVcT was remarkably longer than that of GTVMRI [(5.21 ±1.65) cm vs.(4.46 ± 1.51) cm,t =5.059,P ＜0.05].The mean volume of GTVcTWaS significantly larger than that of GTVMRI[(55.71 ±31.57) cm3vs.(44.02 ±25.11) cm3,t=6.977,P＜ 0.05)].The mean distance of distal tumor to the anal verge was (3.72 ± 0.93) cm,significantly longer than that of lower bounds of GTVCT to the anal verge,which had a high consistency with GTVMRI.The IMRT plan was based on CT-MRI fusion images.There were no 3-4 grade adverse effects of radiotherapy.The overall pCR rate was 32.5％.Conclusions MRI simulation could define smaller GTV and more precise lower bounds than CT.With improved accuracy of target volumes contours,the application of MRI simulation may promote the efficacy of radiotherapy and result in a reduction in the incidence of toxicities.

Objective To elaborate the glucose and lipid metabolism 1 year postpartum on the foundation of postpartum 6-12 weeks in patients with prior gestational abnormal glucose metabolism in Beijing area.Methods Seventy-three patients who delivered during February to December,2007,aged (32.0 ± 3.6) years,were enrolled.46 cases (63％) were diagnosed as cases of gestational diabetes mellitus (GDM) while 27 (37％) as gestational impaired glucose tolerance (GIGT).All of the patients were revisited twice by 6-12 weeks and 1 year postparaum.Body weight,waist andhip circumferences,oral glucose tolerance test(OGTT),and lipids profile were determined.Results Compared with 6-12 weeks postpartum,the body weight,waist and hip circumferences,and waist-to-hip ratio were decreased by 1 year postpartum,fasting plasma glucose was increased [(5.19 ± 0.06) vs (4.84 ± 0.57) mmol/L,P＜0.01],and 4 cases were diagnosed as cases with impaired fasting glucose (IFG; 4 vs 0).By 6-12 weeks and 1 year postpartum,postprandial plasma glucose levels were (6.84± 1.93) and (7.33 ± 1.50) mmol/L(P=0.017),and the incidences of impaired glucose tolerance(IGT) were 28.8％ and 38.4％ (P=0.167),respectively,with 6 cases of newly diagnosed IGT by 1 year postpartum.There were more cases of hypertriglyceridenia (19.2％ vs 13.7％),less cases of hypercholesterolemia(19.7％ vs 30.0％,P＜0.01),more cases with improved high-densit.y lipoprotein-cholesterol (21.9％ vs 4.1％,P＜0.01),and less cases with raised low-density lipoproteincholesterol(21.9％ vs 49.3％,P＜0.01).No difference was found in body weight,body mass index,waist circumference,hip circumference,and waist-to-hip ratio between GIGT and GDM groups.Conclusion GDM is an important cause of the increasing prevalence of diabetes in women of reproductive age.Although body weight and waist-to-hip ratio have been improved,they would still develop glucose intolerance and dyslipidemia 1 year postpartum.