A good social network can ensure the safety of women during pregnancy and reduce the incidence of adverse pregnancy outcomes. However, there is currently relatively little research on the overall social network of pregnant women, and the influencing factors of the overall social network of pregnant women are not yet clear. This paper reviews the current situation, influencing factors, and measurement tools of the social network in pregnant women, aiming to improve their social network, help them access high-quality nursing resources, ensure the health of pregnant women and infants, and decrease the incidence of adverse pregnancy outcomes.

Objective:To explore the correlation among undergraduate nursing students' attitudes towards the aged, family intimacy and sense of meaning in life, so as to provide a reference for improving undergraduate nursing students' attitudes towards the aged.Methods:This study was a cross-sectional study. Convenience sampling was used to select 385 undergraduate nursing students from 3 universities in Shandong Province as the research objects. The survey was conducted using the General Information Questionnaire, Kogan's Attitudes toward Older People Scale (KAOPS) , Family Intimacy Subscale and Meaning in Life Questionnaire (MLQ) . The correlation among undergraduate nursing students' attitudes towards the aged, family intimacy and sense of meaning in life was analyzed by Pearson correlation. The influencing factors of undergraduate nursing students' attitudes towards the aged were analyzed by multiple linear regression. In this study, a total of 385 questionnaires were distributed and 348 valid questionnaires were returned with an effective response rate of 90.39%.Results:Among those undergraduate nursing students, the KAOPS total score was (165.58±23.24) , and the Family Intimacy Subscale score was (70.16±9.75) , and the MLQ total score was (52.84±9.58) . The score of Family Intimacy Subscale, the total score and the dimension scores of MLQ were positively correlated with the KAOPS total score and dimension scores of undergraduate nursing students ( r=0.190-0.450; P<0.01) . The results of multiple linear regression analysis showed that gender, experience in geriatric nursing practice, willingness to engage in geriatric nursing work, relationship with the aged, family intimacy, and sense of meaning in life were the influencing factors of undergraduate nursing students' attitudes towards the aged ( P<0.05) , explaining 30.1% of the total variation. Conclusions:Undergraduate nursing students generally have a positive attitude towards the aged, but there is still room for improvement. In the future, the intervention research on family intimacy and sense of meaning in life of undergraduate nursing students should be strengthened, so as to guide undergraduate nursing students to have a more positive attitude towards the aged and improve the quality of geriatric nursing services.

Objective:To investigate the application value of dual-graft living donor liver transplantation of right segment from an adult living donor combined with a left lateral segment from donation after brain death for hepatocellular carcinoma (HCC).Methods:The retrospective and descriptive study was conducted. The clinicopathological data of a male 46-year-old patient with HCC who underwent dual-graft living donor liver transplantation of right segment from an adult living donor combined with a left lateral segment from donation after brain death at the West China Hospital of Sichuan University in October 2019 were collected. He weighed 66 kg and was 171 cm in height. His blood type was A Rh-positive. Graft one was from a female 23-year-old living donor who had a bodyweight of 50 kg, a height of 150 cm, and blood type of A Rh-positive; graft two was from a male 44-year-old brain death donor with the blood type of A Rh-positive. The surgery was performed in three operating rooms, graft one and graft two were obtained simultaneously in two operating rooms, and the recipient′s liver was dissected in the third operating room. When the in vitro splicing of the liver was almost completed, surgeons entirely removed the recipient′s liver and started to transplant the new one. Observation indicators: (1) surgical situations and postoperative recovery of the living donor and the recipient; (2) postoperative pathological examination of the recipient′s liver; (3) follow-up. Follow-up was conducted by outpatient examinations, including monitoring of HCC recurrence, monitoring of new liver function, monitoring and adjustment of immunosuppressive agents, detection of biliary vascular complications, rejection and adverse drug reactions. Regular lifelong follow-up was required for recipients, with the latest follow-up on December 4, 2019. Count data were expressed as absolute numbers or percentages.Results:(1) Surgical situations and postoperative recovery of the living donor and the recipient: operation time, volume of intraoperative blood loss, volume of intraoperative infusion of autologous blood of the living donor were 315 minutes, 200 mL, 200 mL, respectively. The living donor was discharged from hospital on the sixth day after surgery without any complications. The recipient underwent modified piggyback liver transplantation successfully. Graft one was from the right segment free of the middle hepatic vein in the living donor, with a weight of 410 g. Graft two was from the left lateral segment in the donor after brain death, with a weight of 400 g. The graft from donors to recipient weight ratio was 1.2% after splicing. The operation time, duration of anhepatic phase, volume of intraoperative blood loss, volume of intraoperative blood transfusion were 815 minutes, 60 minutes, 1 500 mL, 1 800 mL, respectively. The recipient′s temperature was normal during hospitalization. On the first postoperative day, the level of white blood cell and neutrophilic granulocyte percentage of the recipient reached a peak (17.15×10 9/L and 91.7%, respectively) and then gradually decreased. After anti-infective treatment with piperacillin sodium and sulbactam sodium, both of the two indicators returned to normal on the seventh day after surgery (7.90×10 9/L and 70.9%, respectively), and the antibiotic was discontinued. During the hospitalization, the level of albumin of the recipient fluctuated in 31.0-41.4 g/L, the liver function parameters including total bilirubin, alanine aminotransferase, aspartate aminotransferase, prothrombin time and international normalized ratio gradually returned to normal levels, and the renal function parameters including creatinine and estimated glomerular filtration rate remained within the normal range. On the tenth day after surgery, the recipient was in good condition and discharged from the hospital. (2) Postoperative pathological examination of the recipient′s liver: ① results of the pathological examination showed moderately differentiated HCC with incomplete tumour capsule and no invasion of the liver capsule. The surrounding liver tissues showed hepatitis B-related nodular cirrhosis, and no tumor involvement was detected at the broken end of the hilum. ② The gallbladder presented chronic cholecystitis accompanied by cholesterol deposition, and one abdominal lymph node showed reactive hyperplasia. The immunohistochemical staining showed 10% positive HBsAg and negative HBcAg. (3) Follow-up: the tumor markers of the recipient were tested on November 19, 2019, including α-fetoprotein (2.92 μg/L) and abnormal prothrombin (16 AU/L). Together with the negative result of abdominal colour doppler ultrasound, they collectively indicated no HCC recurrence in the recipient. The liver function parameters including total bilirubin (8.6 μmol/L), alanine aminotransferase (23 IU/L), aspartate aminotransferase (28 IU/L) and albumin (44.0 g/L) of the recipient tested on December 3, 2019, were all in normal levels. Blood concentration of tacrolimus was 4.2 μg/L . The drug dose of mycophenolate mofetil dispersible tablets was adjusted to 250 mg given twice daily, and the drug dose of others was unchanged (tacrolimus 2 mg, once daily; sirolimus 1mg, once daily). No symptoms, signs or examination results indicated biliary vascular complications, rejection or adverse drug reactions. Conclusion:Dual-graft living donor liver transplantation of right segment from an adult living donor combined with a left lateral segment from donation after brain death is safe and effective, which can be used as a suboptimal treatment for patients with HCC beyond Milan criteria.

Objective To understand the incidence and risk factors of warfarin related hemorrhagic events during anticoagulation therapy with warfarin in patients with cirrhosis and portal vein thrombosis (PVT)after transjugular intrahepatic portosystemic shunt (TIPS). Methods The patients with liver cirrhosis who were treated with warfarin after TIPS due to portal hypertension were followed up from January 2012 in Xijing Hospital of Digestive Diseases,Air Force Military Medical University. The data of medical records and follow-up records up to the end of December 2015 in patients undergoing TIPS were collected and retrospectively analyzed. Cumulative incidence of hemorrhagic events related to warfarin treatment was calculated by Kaplan-Meier method. The patients were divided into warfarin-related bleeding group (bleeding group ) and non warfarin-related bleeding group (non-bleeding group ). The risk factors of hemorrhagic events related to warfarin treatment were analyzed using Cox regression model and the hazard ratio (HR)and the 95% confidence interval (CI)were calculated. Results A total of 179 patients were enrolled,including 117 males and 62 females with ages of 25-79 years and average age of (52 ± 12)years;the bleeding group comprised 47 patients (26.3%)and the non-bleeding group comprised 132 patients (73.7%). The follow-up time after discharge ranged 1-74 months and the average time was (28 ± 21) months. The average portal pressure gradient dropped from (25.4 ± 5.2)to (8.7 ± 3.7)mmHg before and after TIPS (P＜0.001). The median dose of oral warfarin in patients in the bleeding group was 2.5 (ranged from 2.5 to 3.75)mg and the median INR was 3.12 (ranged from 2.04 to 9.41);the median dose of oral warfarin in patients in the non-bleeding group was 1.8 (ranged from 0.63 to 2.5)mg and the median INR was 1.85 (ranged from 1.5 to 3.38). Fifty eight cases of hemorrhagic events occurred in 47 patients in the bleeding group,including 24 cases of gingival bleeding,16 cases of epistaxis,8 cases of cutaneous purpura, 4 cases of conjunctival hemorrhage,2 cases of hemorrhage of digestive tract,2 cases of intracranial hemorrhage,1 cases of hematuria,and 1 cases of menorrhagia. Nine of the 47 patients in the bleeding group had bleeding from multiple sites. The results of Kaplan-Meier analysis showed that the 1-,2-,3-,4-,5-and 6-year cumulative incidences of hemorrhagic events related to warfarin treatment after operation were 19%,23%,24%,30%,41%,and 45%,respectively. Warfarin was stopped in 11 patients and given at reduced doses in 36 patients among the 47 patients in the bleeding group. After that,43 patients'hemorrhagic symptoms disappeared and 3 patients' symptoms relieved,and then warfarin treatments were continued,except that 1 patient with a long history of hypertension died of intracranial hemorrhage. Multiple Cox regression analysis showed that the baseline serum creatinine level ＞115 μmol/L was an independent risk factor for hemorrhagic events related to warfarin treatment (HR＝1.82,95%CI:1.01-3.28,P＝0.045). Conclusions It is relatively safe for patients with liver cirrhosis and PVT receiving warfarin anticoagulation therapy after TIPS. Elevated serum creatinine is an independent risk factor for hemorrhagic events related to warfarin treatment.

Objective To understand the incidence and risk factors of warfarin related hemorrhagic events during anticoagulation therapy with warfarin in patients with cirrhosis and portal vein thrombosis (PVT)after transjugular intrahepatic portosystemic shunt (TIPS). Methods The patients with liver cirrhosis who were treated with warfarin after TIPS due to portal hypertension were followed up from January 2012 in Xijing Hospital of Digestive Diseases,Air Force Military Medical University. The data of medical records and follow-up records up to the end of December 2015 in patients undergoing TIPS were collected and retrospectively analyzed. Cumulative incidence of hemorrhagic events related to warfarin treatment was calculated by Kaplan-Meier method. The patients were divided into warfarin-related bleeding group (bleeding group ) and non warfarin-related bleeding group (non-bleeding group ). The risk factors of hemorrhagic events related to warfarin treatment were analyzed using Cox regression model and the hazard ratio (HR)and the 95% confidence interval (CI)were calculated. Results A total of 179 patients were enrolled,including 117 males and 62 females with ages of 25-79 years and average age of (52 ± 12)years;the bleeding group comprised 47 patients (26.3%)and the non-bleeding group comprised 132 patients (73.7%). The follow-up time after discharge ranged 1-74 months and the average time was (28 ± 21) months. The average portal pressure gradient dropped from (25.4 ± 5.2)to (8.7 ± 3.7)mmHg before and after TIPS (P＜0.001). The median dose of oral warfarin in patients in the bleeding group was 2.5 (ranged from 2.5 to 3.75)mg and the median INR was 3.12 (ranged from 2.04 to 9.41);the median dose of oral warfarin in patients in the non-bleeding group was 1.8 (ranged from 0.63 to 2.5)mg and the median INR was 1.85 (ranged from 1.5 to 3.38). Fifty eight cases of hemorrhagic events occurred in 47 patients in the bleeding group,including 24 cases of gingival bleeding,16 cases of epistaxis,8 cases of cutaneous purpura, 4 cases of conjunctival hemorrhage,2 cases of hemorrhage of digestive tract,2 cases of intracranial hemorrhage,1 cases of hematuria,and 1 cases of menorrhagia. Nine of the 47 patients in the bleeding group had bleeding from multiple sites. The results of Kaplan-Meier analysis showed that the 1-,2-,3-,4-,5-and 6-year cumulative incidences of hemorrhagic events related to warfarin treatment after operation were 19%,23%,24%,30%,41%,and 45%,respectively. Warfarin was stopped in 11 patients and given at reduced doses in 36 patients among the 47 patients in the bleeding group. After that,43 patients'hemorrhagic symptoms disappeared and 3 patients' symptoms relieved,and then warfarin treatments were continued,except that 1 patient with a long history of hypertension died of intracranial hemorrhage. Multiple Cox regression analysis showed that the baseline serum creatinine level ＞115 μmol/L was an independent risk factor for hemorrhagic events related to warfarin treatment (HR＝1.82,95%CI:1.01-3.28,P＝0.045). Conclusions It is relatively safe for patients with liver cirrhosis and PVT receiving warfarin anticoagulation therapy after TIPS. Elevated serum creatinine is an independent risk factor for hemorrhagic events related to warfarin treatment.