Objective To understand the status of intra-abdominal hypertension(IAH)in children after liver transplantation,and to analyze the risk factors,to provide references for clinical medical staff to identify high-risk early,and formulate the prevention and intervention program of IAH after liver transplantation.Methods A prospective cohort study was conducted,and the clinical data of 208 children who received liver transplantation from October 2021 to June 2023 in a tertiary hospital in Zhejiang Province were enrolled.The status of IAH after liver transplantation was described,and participants were divided into 2 groups according to transbladder monitoring intra-abdominal pressure levels.Children with ≥10 mmHg(1 mmHg=0.133 kPa)was classified as an intra-abdominal hypertension group,while those with＜10 mmHg was classified as a non-intra-abdominal hypertension group.Results There were 51 cases(24.52％)which had IAH,including 12 cases(23.53％)of grade I to Ⅱ and 39 cases(76.47％)of grade Ⅲ to Ⅳ in 208 intra-abdominal hypertension in children after liver transplantation.Binary Logistic regression analysis showed that the graft to recipient weight ratio(OR=1.391),duration of postoperative mechanical ventilation(OR=1.006),and postoperative central venous pressure(OR=1.375)were independent risk factors for IAH(P＜0.05).Conclusion The incidence of IAH in children after liver transplantation were high.Greater graft to recipient weight ratio,longer mechanical ventilation time,higher central venous pressure could increase the risk of IAH.During clinical practice,more emphasis should be strengthened on the abdominal pressure dynamic monitoring and providing timely intervention to reduce the occurrence of IAH,and improving the prognosis of children after liver transplantation.

To summarize the perioperative nursing care in 32 cases of pancreatic cancer undergoing radical surgery combined with intestinal autotransplantation.Key points:to set up a multidisciplinary surgical team and create surgical emergency plans;to well prepare equipment,supplies,and environment;to utilize node control concepts to control operation safety;to carry out the clustered surgical infection management and phased implementation of isolation technology;to prevent and control the inadvertent perioperative hypothermia;organ irrigation,repair and preservation;to prevent the complication.After above precise surgical cooperation and meticulous care,all operations were implemented successfully,and patients were transferred to the intensive care unit for further treatment safely.

Objective In this research,we constructed a nurse-led intra-abdominal pressure(IAP)management program in children undergoing liver transplantation,and explored its clinical application effect.Methods Based on literature review,semi-structured interviews,and expert meetings,a nurse-led program for IAP management is constructed.By convenience sampling method,162 children admitted to the pediatric liver transplant intensive care unit of a tertiary hospital in Zhejiang Province from January to December 2023 were selected.The experimental group implemented a nurse-led IAP management program,while the control group received routine postoperative care after liver transplantation.The average IAP values during ICU period,incidence and grading of intra-abdominal hypertension(IAH),duration of mechanical ventilation,and length of ICU stay were compared between 2 groups.Results Finally,the IAP management program in children undergoing liver transplantation included 4 first-level items,10 second-level items and 20 third-level items.During the application of this program,4 cases dropped,and 78 cases were finally included in the experimental group and 80 cases in the control group.After the intervention,the IAP value in the experimental group was(8.63±2.40)mmHg(1 mmHg=0.133 kPa),lower than(9.23±3.19)mmHg in the control group,but there was no statistically significant difference between the 2 groups(P=0.186).The incidence of IAH in the experimental group was 23.07％,lower than 41.25％in the control group.The difference between the 2 groups was statistically significant(P=0.015).13 cases(16.67％)in the experimental group developed grade Ⅰ IAH,while 22 cases(27.50％)in the control group;5 cases(6.41％)in the experimental group developed grade Ⅱ IAH,while 9 cases(11.25％)in the control group;no cases in the experimental group developed grade Ⅲ IAH,while 2 cases(2.50％)in the control group.There was no statistically significant difference between the 2 groups(P＞0.05).The mechanical ventilation time in the experimental group was 3.00(1.00,13.25)hours,and 7.50(1.00,27.75)hours in the control group.The difference between the 2 groups was statistically significant(P=0.034).The length of ICU stay in the experimental group was 6.00(4.00,8.25)days,and 5.00(3.00,8.00)days hours in the control group.The difference between the 2 groups was statistically significant(P=0.061).Conclusion The nurse-led IAP management program in children undergoing liver transplantation can effectively reduce the incidence of IAH,shorten the duration of mechanical ventilation.

Objective To review the research on the application of clinical decision support system(CDSS)involving nurses in depression both domestically and internationally.Methods 10 Chinese and English databases including PubMed,Web of Science,Scopus,CINAHL,PsycINFO,Embase,Cochrane Library,CNKI,Wanfang Database,and VIP were searched until March,2024.The eligible literature of the application of CDSS involving nurses in depression was selected to analyze the basic characteristics of studies,the functions,characteristics,feasibility,and effectiveness of CDSS.Results Finally,16 English articles involving 13 CDSS were included.This study found that nurses participating in CDSS can improve the degree of depression in patients,but its application in depression management is mainly for screening,and few CDSS can propose personalized depression management programs based on the psychological and social factors of patients.Conclusion The CDSS involving nurses can promote the screening of depression and improve depression in patients,but it fails to propose a personalized depression management program.Future research can develop CDSS based on electronic medical record systems to facilitate nurses'screening for depression and further develop an intelligent management module for CDSS to provide intelligent and personalized management solutions for patients with depression.

Objective To investigate the current status of frailty in liver transplant candidates and to analyze the influencing factors.Methods The convenience sampling method was used to select 150 liver transplant candidates who were hospitalized in the Department of Liver Transplantation of a tertiary hospital in Hangzhou from July 2022 to July 2023.They were investigated by the general patient data,Fried Frailty Phenotype,Barthel Index,Nutrition Risk Screening 2002,General Health Status Scale.Statistical methods including single factor and multifactor analysis were conducted for influencing factors of frailty in liver transplant candidates.Results The pre-frailty and frailty rates in 145 liver transplant candidates were 42.07％and 45.52％,respectively,and only 12.41％were non-frailty.The results of ordered multiple Logistic regression showed that age,total bilirubin,hemoglobin,and general health status were influential factors in the frailty of liver transplant candidates(P＜0.05).Conclusion Liver transplant candidates have a high incidence of frailty.Age,total bilirubin,hemoglobin,and general health status are influential factors in frailty.Nurses should pay attention to the assessment of frailty in liver transplant candidates,and take timely and targeted nursing interventions to prevent or delay the occurrence and development of frailty.

Objective To explore the application effect of"three-station"teaching rounds in standardized training teach-ing rounds of general surgery residents.Methods 50 trained doctors from the general surgical base from July 2022 to July 2023 were randomly selected and divided into two groups,with 25 patients in each.The observation group used a"three-station"teaching ward round,while the control group used a traditional teaching ward round mode.The exam scores,ward round effects,satisfaction,and experience were compared.Results The total scores of the observation group were significantly higher than those of the control group(P＜0.05),and the scores of the medical history collection and physical examination in the case anal-ysis test and skill test were significantly higher than those of the control group(P＜0.05).There was no significant difference in the theoretical test scores between the two groups(P＞0.05).The proportion of"Yes"in the questionnaire of the observation group was higher than that of the control group in the aspects of improving the diagnosis and treatment of diseases,clinical think-ing,doctor-patient communication ability and increasing learning interest(P＜0.05).The satisfaction of questionnaire teaching round in the observation group was 84.0％,significantly higher than that in the control group(60.0％)(P＜0.05).In the observation group,the percentages of the attending physicians and the teaching rounds were 64.0％and 68.0％,respectively,which were significantly higher than those of the control group(28.0％and 32.0％,P＜0.05).Conclusion The"three-sta-tion"teaching ward round can improve the exam scores,ward round effectiveness and satisfaction,improve the experience of attending physicians and teaching ward round subjects,and is worth promoting in various resident training bases.

Purpose Based on liver lesions,to investigate the feasibility and influencing factors of virtual non-contrast(VNC)replacing true non-contrast(TNC)in tri-phase derived from Revolution CT.Materials and Methods A total of 62 patients who underwent TNC and tri-phase(arterial,venous,and delayed phases)spectral enhanced liver scans were retrospectively enrolled in Zhongda Hospital Affiliated to Southeast University from December 2021 to April 2022.Liver lesions with a diameter of≥5 mm were measured and categorized into Group 1(≤20 Hu)and Group 2(>20 Hu)according to the CT values of TNC,then were respectively further categorized into group a(≤20 Hu across all three phases of enhancement)and group b(>20 Hu in at least one phase of enhancement)based on the degree of enhancement.CT attenuation,maximum diameter and detection rates of lesions were compared between TNC and three-phase VNC groups.Multivariate regression analysis was used to investigate the influencing factors of the density difference between VNC and TNC.Results A statistically significant difference in the attenuation of lesions was observed among the each groups(χ2/F=14.712,18.603,7.334,all P<0.01).Except for VNCV and VNCD in Group-1a which had no significant difference with TNC(both P>0.05),the attenuation of other VNCs were lower than TNC in category-a and greater than TNC in category-b(all P<0.05).Maximal diameter presented strong correlation and no significant difference in VNCA and VNCV compared to TNC in each group(all P>0.05;all r>0.8 and P<0.001).A significant difference in the detection rate of the lesions was observed among the groups(χ2=47.660,P<0.001),VNCV images displayed the higher detection rate than VNCA and VNCD(all P<0.05).The density difference between VNC and TNC was positively correlated with CT values of the corresponding enhancement phase(r2adjusted=0.209,0.142,0.062,P<0.001).Conclusion Based on Revolution CT,VNCV is the optimal phase to replace TNC and can be mitigated by CT value of the lesions in venous-phase.

Selecting high-quality patient report outcome measures for patients with liver transplantation may properly assess health condition from their perspective, assist nurses in identifying patients′ reports of health issues, and deliver targeted nursing care for them. This paper reviewed the current status of researches on measurement tools for patient reported outcomes in liver transplantation both domestically and internationally, including the content, characteristics, disadvantages and situation recommendations of the generic and specific measurement tools. The purpose is to provide a reference for choosing patient reported outcomes measurements, symptom management as well as the caring strategies in liver transplantation.

Cholangiocarcinoma is a highly heterogeneous tumor with an insidious onset,severe conditions,a high degree of malignancy,and an extremely poor prognosis.Glucose is a major energy source for the proliferation and metastasis of cholangiocarcinoma,and the glucose metabolism pathway of cholangiocarcinoma cells will be re-edited in the process of rapid proliferation to produce a large amount of energy for their own needs.Traditional Chinese medicine has unique advantages in the treatment of cholangiocarcinoma,and studies have shown that the active components of traditional Chinese medicine can inhibit the development and progression of cholangiocarcinoma by regulating glucose metabolism.This article reviews the characteristics of glucose metabolism in cholangiocarcinoma and the role of the active components of traditional Chinese medicine in regulating glucose metabolism against cholangiocarcinoma,in order to provide new ideas for the treatment of cholangiocarcinoma.

The "pre-disease" theory of traditional Chinese medicine focuses on the dynamic and continuous evolution from health to disease, and emphasizes early identification and intervention in the complex and gradual process of evolution from health to disease. The "pre-disease" theory and complexity science share the same perspective on health and disease from the standpoint of features of the dynamic evolution and holism, i. e., life is considered as a complex system with ongoing dynamic changes, which exhibit the nonlinear features of " homeostasis-destabilization-phase transition-another homeostasis". In this paper, from the perspective of nonlinear dynamics in complexity science, we explain the scientific connotation of the evolution law of "pre-disease"-disease based on the theory of critical slowing down in traditional Chinese medicine. Based on the theory of critical slowing down and the dynamic network biomarker method generated by its development, combined with the macro signs of comprehensive analysis of data gained by four diagnostic method and the micro features including transcriptomics and the microbiomics, this paper proposes to integrate macro and micro multi-hierarchy information to construct a "pre-disease" critical slowing down identification model with the characteristics of traditional Chinese medicine diagnosis and treatment, which provides a new perspective and method for the early warning of complex diseases.